Comparison of 'primary repair' and 'placing a drain without repair' methods in duodenum perforations.

Turgay Karataş, Murat Kanlioz, Nurcan Göktürk, Furkan Çevirgen, Yusuf Turkoz, Azibe Yıldız, Ahmet Kadir Arslan, Engin Burak Selçuk, Mehmet Karataş, Davut Özbağ
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Abstract

Background: Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of 'primary repair' and 'drain placement without repair' methods in duodenal perforations using an animal model.

Methods: Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-β1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically.

Results: There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-β1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05).

Conclusion: We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.

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十二指肠穿孔“一期修复”与“不修复引流”方法的比较。
背景:十二指肠溃疡穿孔是一种严重的疾病。许多方法已经确定并用于外科治疗。在这项研究中,目的是通过动物模型比较“初级修复”和“不修复引流管放置”方法在十二指肠穿孔中的有效性。方法:将大鼠分成3组,每组10只。第一组(初次修复/缝合组)和第二组(放置引流管而不修复/不缝合引流组)十二指肠穿孔。第一组用缝线修复穿孔。在第二组中,只在腹部放置引流管而不缝合。第三组(对照组)仅行剖腹手术。于术前及术后第1、7天对动物进行中性粒细胞计数、沉降、血清c反应蛋白(CRP)、血清总抗氧化能力(TAC)、血清总硫醇、血清天然硫醇和血清髓过氧化物酶(MPO)分析。进行组织学和免疫组织化学(转化生长因子-β1 [TGF-β1])分析。对两组的血液分析、组织学和免疫组织化学结果进行统计学比较。结果:第一组与第二组除术后第7天TAC、第1天MPO值差异无统计学意义(P>0.05)。虽然第二组的组织愈合较第一组明显,但两组间差异无统计学意义(P>0.05)。第二组观察到的TGF-β1免疫反应性明显高于第一组(p)。结论:我们认为无缝线引流法治疗双肾溃疡穿孔与一期修复法同样有效,可作为一期修复法的替代方法安全应用。然而,需要进一步的研究来充分确定无缝线引流方法的疗效。
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来源期刊
CiteScore
1.40
自引率
18.20%
发文量
82
审稿时长
4-8 weeks
期刊介绍: The Turkish Journal of Trauma and Emergency Surgery (TJTES) is an official publication of the Turkish Association of Trauma and Emergency Surgery. It is a double-blind and peer-reviewed periodical that considers for publication clinical and experimental studies, case reports, technical contributions, and letters to the editor. Scope of the journal covers the trauma and emergency surgery. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in their fields in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent reviewer to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions.
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