الفهرس 
? Duodenal UlcersOnly 14 pages are availabe for public view
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Abstract
Background: A duodenal perforation is a possible fatal lesion. Duodenal perforations are caused by a variety of factors, including peptic ulcer disease and other iatrogenic causes. The nature of the underlying process that produced the perforation influence the choice of operation.
Aim of the Work: To compare between duodenal exclusion and jejunal serosal patch in the management of perforated duodenal ulcers 2-5 c.m. in diameter regarding postoperative leakage or obstruction.
Patients and Methods: This study will be conducted at (General Surgery Department) at Ain Shams University Hospitals starting from May 2019 to December 2020 with follow up for 1 year postoperatively. In this study we had taken many factors from the data we gathered from the 30 cases divided into 2 study groups, 15 patients undergone jejunal serosal patch repair and other 15 patients undergone duodenal exclusion and gastro-jejunostomy trying to differentiate between the two procedures regarding patients’s data, also to compare between intra-operative time and hospital stay postoperative between both study groups, and in addition to show any significant increase in any of the postoperative complications.
Results: Our study showed that there was increase in operative time in cases undergone duodenal exclusion and gastro-jejunostomy procedure rather than those who undergone jejunal serosal patch repair which reflects technical difficulties accompanying duodenal exclusion procedure which may affect the outcome of the operation on the patients postoperative and also tells that surgical experience is needed for doing this intervention, taking into consideration the patient’s general condition and risk of prolongation of operative time which reflects surgical maturity. It was found that 4 out of 15 patients who undergone duodenal exclusion and gastro-jejunostomy had gastric outlet obstruction within the first 6 months postoperative. And this may be a disadvantage of choosing duodenal exclusion procedure for large perforated duodenal ulcer as occurance of such a complication may lead the patient to suffer from related symptoms as severe frequent vomiting and dehydration and may undergo abdominal exploration again.
Conclusion: It seems that Giant DU perforation (more than 2 c.m.) management represents a unique challenge to the surgeon, as it requires advanced anatomy and technical knowledge. The best surgery for perforation repair has been debated for centuries. Everyday studies try to innovate and find out simple, fast, procedure with minimal complications and suitable for severely-ill patients with giant duodenal perforations. As it needs fast, proper management to prevent mortality, due to extensive duodenal tissue loss associated with surrounding inflammation and fibrosis results in high failure rate for primary closure of giant perforations, therefore surgical procedure planning either exclusion and bypassing of duodenal portion or being patched using serosa of jejunum is case-dependent and requires high surgical experience and skills to get favourable outcomes and try to avoid the above mentioned postoperative complications.