Analysis of surgical treatment of duodenal ulcers with multiple combined complications
The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications.
Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients.
Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %).
Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.
Gisbert, J. P., Calvet, X., Cosme, A., Almela, P., Feu, F., Bory, F. et. al. (2012). Long-Term Follow-Up of 1,000 Patients Cured of Helicobacter pylori Infection Following an Episode of Peptic Ulcer Bleeding. American Journal of Gastroenterology, 107 (8), 1197–1204. doi: http://doi.org/10.1038/ajg.2012.132
Velyhodskyi, N. N. (2019). Osobennosty khyrurhycheskoi taktyky posledneho vremeny pry ostrikh hastroduodenalnikh krovotechenyiakh yazvennoho heneza. Diahnostyka ta likuvannia shlunkovo-kyshkovykh krovotech. Kyiv, 8–10.
Dudka, I. I., Hrynchyk, F. V. (2017). The analysis of the gastroduodenal ulcerous bleeding relapse emergence risk factors. Reporter Vinnytskoho natsionalnoho medychnoho universytetu «Memorial Pyrohova», 1 (21), 31–34.
Korol, Iu. A. (2018). Acute gastroduodenal bleeding ulcer: features of modern treatment straegy. Art of Medicine, 2 (4 (8)), 106–108.
Solomonova, H. A. (2013). Selective proximal vagotomy application for ulcer, complicated with bleeding and penetration treatment. Russian Journal of Gastroenterology, Hepatology, Coloproctology, 5 (42), 21–26.
Shepetko, E. N. (2019). Errors, dangers and complications in surgery of complicated gastroduodenal ulcers. Kiyv: Fenyks, 295.
Yuan, Y., Leontiadis, G. I. (2019). Editorial: ulcer-related vs non-ulcer-nonvariceal upper gastrointestinal bleeding-which has worse outcomes? Alimentary Pharmacology & Therapeutics, 49 (6), 818–819. doi: http://doi.org/10.1111/apt.15144
Quah, G. S., Eslick, G. D., Cox, M. R. (2018). Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair. Journal of Gastrointestinal Surgery, 23 (3), 618–625. doi: http://doi.org/10.1007/s11605-018-4047-8
Søreide, K., Thorsen, K., Harrison, E. M., Bingener, J., Møller, M. H., Ohene-Yeboah, M., Søreide, J. A. (2015). Perforated peptic ulcer. The Lancet, 386 (10000), 1288–1298. doi: http://doi.org/10.1016/s0140-6736(15)00276-7
Søreide, K., Thorsen, K., Søreide, J. A. (2013). Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. British Journal of Surgery, 101 (1), e51–e64. doi: http://doi.org/10.1002/bjs.9368
Giordano, A., Prosperi, P., Alemanno, G., Bergamini, C., Bruscino, A., Valeri, A. G. (2020). Diagnostic and therapeutic role of laparoscopy in perforated peptic ulcer in the elderly patients. Chir, 41 (1), 40–45.
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