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Összefoglaló. Bevezetés: A protonpumpagátló kezelés és Helicobacter pylori eradikáció következtében a fekélyincidencia csökkent, a fekélyből származó vérzések száma is csökkent, ellenben a perforációk előfordulása változatlanul 2–10% között van. A perforáció egy potenciálisan fatális sebészi sürgősségi helyzet, a mortalitás elérheti a 25%-ot, a morbiditás pedig az 50%-ot. Az időben végzett sürgős sebészi kezelés javíthatja az eredményeket. Célkitűzés: A fekélyperforáció nyitott és laparoszkópos módon történt ellátásának összehasonlítása a morbiditás, mortalitás, műtéti idő és ápolási idő alapján. Eredmények: 2017. 01. 01. és 2019. 06. 30. között 55 műtét történt gastro-duodenális fekélyperforáció miatt, 31 műtétet (56,36%) nyitott és 24 műtétet (43,63%) pedig laparoszkópos módon végeztünk. A laparoszkópos csoportban 4 konverzió történt (16,6%). A nyitott műtéti csoportban 23 férfi (átlagéletkor 56,3 év) és 8 nő volt (átlagéletkor 70,3 év), míg a laparoszkópos csoportban 13 férfi (átlagéletkor 49,7 év) és 11 nő (átlagéletkor 53,7 év) volt. A nyitott csoportban 5, a laparoszkópos csoportban 2 szövődmény fordult elő (p = 0,45). Az átlagos műtéti idő a nyitott műtétnél 51,95 perc (30–85), míg a laparoszkópos műtétnél 63,41 (25–110) perc volt (p = 0,13). A nyitott csoportból 6 (átlagéletkor 74,3 év), a laparoszkópos csoportból pedig 2 (átlagéletkor 68,5 év) beteget veszítettünk el 30 napon belül (p = 0,44). Az átlagos ápolási idő a nyitott csoportban 7,13 (5–16), a laparoszkópos csoportban pedig 6,19 (4–13) napnak bizonyult (p = 0,24). Az átlagos perforációméret a nyitott műtéti csoportban 7,4 mm (3–20 mm), míg a laparoszkópos műtéti csoportban 5,3 mm (3–10 mm) volt (p = 0,14). Szabad levegő natív hasi röntgenvizsgálaton a nyitott csoportban 25 esetben (80%), míg a laparoszkópos csoportban 13 esetben volt látható (54%). Megbeszélés: A korai diagnózis, az azonnal kezdett szupportív és antibiotikus kezelés és a sürgős műtét elengedhetetlen az eredmények javításához. A standard műtét a sutura csepleszlebennyel, amit lehet nyitottan és laparoszkóppal is végezni. Bár a viszonylag kis esetszám miatt anyagunkban nem sikerült igazolni a szövődmények arányának szignifikáns csökkenését, az irodalmi adatok alapján a laparoszkópos beavatkozásnak kisebb a morbiditása, mint a nyílt műtétnek, és ha nincs ellenjavallata a laparoszkópiának (anamnézisben többszörös hasi műtét, nem kellő laparoszkópos gyakorlat, felvételkori sokkos állapot és magas életkor), a laparoszkópia általános előnyei miatt és a szabadlevegő-hiány okozta diagnosztikus bizonytalanság esetén is a laparoszkópia első választásként javasolható.

Summary. Introduction: The incidence of peptic ulcer disease decreased due to proton pump inhibitors and Helicobacter pylori eradication. Bleeding from peptic ulcer decreased, as well, although perforation did not decrease and it is permanently between 2–10%. This is a potential surgical emergency, the mortality can reach up to 25% and the morbidity 50%, respectively. Urgent surgical intervention in the right time can improve the results. Aim: To compare the morbidity, mortality, the length of hospital stay and duration of operating time in open and laparoscopic repair of perforated peptic ulcer. Results: A cohort of 55 patients were operated on with perforated peptic ulcer from 01.01.2017 to 30.06.2019 31 open (51.36%) and 24 laparoscopic (43.63%) operations were performed from which 4 (16.6%) needed conversion to open approach. The average age of 23 men and 8 women were 56.3 and 70.3 years respectively in the open operations group, while 13 men and 11 women with average age of 49.7 and 53.7 years was in the laparoscopic operations group. Within 30 days the number of complications were 5 in the open and 2 in the laparoscopic group (p = 0.45). The average duration of operation was 51.95 minutes (30–85) in the open and 63.41 minutes (25–110) in the laparoscopic group (p = 0.13). 6 from the open group with average age of 74.3 years and 2 from the laparoscopic group with average age of 68.5 years died within 30 days (p = 0.44). The average length of stay was 7.13 (5–16) days in the open and 6.19 (4–13) days in the laparoscopic group (p = 0.24). The average size of the perforation was 7.4 mm (3–20) in the open and 5.3 mm (3–10) in the laparoscopic group (p = 0.14). Free air was seen in the abdominal cavity in 25 cases (80%) of the open and in 11 cases (54%) of the laparoscopic group. Conclusion: Early diagnosis, prompt supportive care and antibiotic treatment and urgent surgical intervention are essential to improve outcomes. The standard operation is the simple suture with pedicled omental flap which can be performed by either open or laparoscopic surgical repair. Laparoscopic method spreads slowly, the learning curve is longer and it needs more expertise but the morbidity is lower than that of the open surgery. The morbidity does not increase after conversion according to the literature so if there is no contraindication and there is enough expertise it should be suggested as the first choice.

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