Surgical Treatment of Bleeding Ulcer in Cases When the Gastroenterological and Radiological Approach is Insufficient or Disabled - Single Center Expirience.

Abstract

Background: Urgent surgical treatment of bleeding gastric and duodenal ulcer is indicated in cases where there is no treatment by an interventional gastroenterologist and radiologist readily available, or there is no satisfactory response to the applied interventional procedure.

Objective: The aim of our study is to show that there is the still large number of patients with massive bleeding gastric or duodenal ulcers who had to undergo emergency surgery, in order to achieve hemostasis, provide survival analisys, and to present a methode of the surgical procedure which we perfomed.

Methods: This study analysed 49 patients in the period of 5 years (2013-2018), who underwent emergency surgery due to bleeding ulcer. All patients had one or more gastroscopies in order to stop the bleeding, which were ineffective. Surgical treatments which are used in managing ulcer bleedings depended on the localization of the lesion and how severe the bleeding is. Indicated treatment is direct compression of a bleeding blood vessel (ulcer niche), truncal vagotomy, pyloroplasty, gastroduodenal artery ligature, ligature of the right gastroepiploic artery. Resection procedures were performed as well: antrectomy, proximal, subtotal and total gastrectomy. All surgical treatments aimed to preserve the patients of gastrointestinal tract where such an approach could be carried out.

Results: There were total of 49 patients who underwent surgical treatment of bleeding ulcer of which 31 are male (63,27%) and 18 are female (36,73%). The survival was 38,78% (19 patients); mortality 61,22% (30 patients). The most common surgical treatment was direct suture of a bleeding vessel with a ligature of the gastroduodenal and right gastroepiploic artery. When we observe the results of resection procedures subtotal gastrectomy was most commonly used. Surgical procedure performed were bilateral vagotomy, ligature of gastroduodenal and right gastroepiploic artery if the ulcer is localized in the antral, pyloric or duodenal region and not penetrating showed that there is no need for gastrotomy/duodenotomy and direct suturing of the bleeding vessel significantly reduces operative procedure, and saves the patient from additional surgical trauma and allows the desired hemostasis. In 5-10% of patients with bleeding ulcers, emergency surgery is indicated due to massive bleeding and hemorrhagic shock and then surgery is the only chance of survival. The primary goal of any surgery for bleeding ulcer is to establish bleeding control. massive ulcer bleeding. All these patients did not have the opportunity to avoid surgery and stop the bleeding with the treatment of an interventional gastroenterologist and radiologist. Survival is 38.78%, mortality is still high 61.22% but it is encouraging that without the application of surgical treatment it would be 100% in this group of patients.

Conclusion: Regardless of the risk posed by surgical treatment of a bleeding ulcer, it still brings the patient the only chance for life in cases when the interventional radiological and gastroenterological approach has failed or been disabled. Surgical treatment of bleeding ulcer in cases when the gastroenterological and radiological approach is insufficient or disabled - Single center experience.