SELECTION OF OPTIMAL TREATMENT METHODS IN EMERGENCY SURGICAL INTERVENTIONS FOR PERFORATED DUODENAL ULCER

Duodenal perforation, which is one of the most serious complications of peptic ulcer disease, requires im­mediate surgical intervention. Despite advances in diagnostic techniques, the development of minimally invasive surgery, and the implementation of modern perioperative management protocols, the selection of the most appro­priate surgical technique and extent of intervention remains a relevant clinical issue. Timely recognition of perforation, assessment of peritonitis severity, determination of operative and anesthetic risks, and individualization of the surgical approach play a crucial role. The present study aims to examine contemporary strategies for selecting optimal methods of emergency surgical treatment in patients with perforated duodenal ulcers. Particular consideration is given to factors such as the patient's clinical condition, duration of the disease, size and location of the perforation defect, severity of inflamma­tory changes, and the presence of comorbidities. The advantages and limitations of conventional open ulcer closure, laparoscopic repair of the perforation, omental patch techniques, and more extensive surgical procedures in complicated cases are analyzed. Special atten­tion is paid to the differentiated selection of surgical access, adequate abdominal cavity sanitation, rational antibiotic therapy, prevention of postoperative complications, and subsequent anti-ulcer treatment. Based on the analysis of clinical approaches, the necessity of an individualized strategy for selecting the surgical procedure is substantiated. In patients with small perforation defects and stable clinical conditions, organ-preserving primary closure, including laparoscopic repair when appropriate facilities and expertise are available, may be preferable. In cases involving large perforation defects, severe peritonitis, hemodynamic instability, and technical difficulties, the extent of surgery should be determined individually, taking surgical risks into account. Thus, improving emergency surgical management of perforated duodenal ulcers should be based on a comprehensive assessment of the patient's clinical condition, the anatomical characteristics of the ulcer defect, and the available resources of the surgical hospital. A differentiated approach to selecting the treatment method may contribute to reducing the risk of postoperative complications, improving treatment outcomes, and shortening the rehabilitation period.