ACTA FAC. MED. NAISS. 2007;24(3):125-134

  Original article

TREATMENT PROCEDURES IN ACUTE GASTRIC AND DUODENIC BLEEDING ULCERS

Ivana Djordjevic¹

Aleksandar Zlatic¹

Ivan Pesic¹

Irena Jankovic²

¹Surgical Clinic Clinical Center Nis

²Medical Statistics, Faculty of Medicine in Nis

    SUMMARY

   Profuse bleeding of upper parts of gastrointestinal tract is an emergency medical condition, requiring intensive re-animation and treatment by gastroenterologist and surgeon. The most frequent causes of such hemorrhage are esophagus varices and acute bleeding, gastric and duodenal ulcers.

    Until ten years ago, surgical treatment of acute gastric and duodenic bleeding ulcers (AGBDU) had been a method of choice. Today, urgent surgical treatment is a choice only if an endoscopic therapeutical intervention is impossible, or in case of persistent or recurrent bleeding.

    The aim of our research was to determine the optimum treatment of AGBDU, as well as its frequency, types of applied surgical procedures, postoperative complications and the mortality rate. The research comprises a prospective-retrospective study of patients treated at the Nis Surgical Clinic in the period 1994-2005.

    The subjects were divided in two groups: A (patients treated from 2000-2005) and B (patients treated from 1994-1999). The division was based on the introduction and application of new approaches in diagnosis and urgent endoscopic procedures, improvement of reanimation techniques and a more active approach to the surgical treatment of AGBDU, with respect to the principles of gastroduodenal surgery. 

    There is no significant discrepancy in the number of subjects (group A-218, group B-233) and the types of performed surgical procedures. Significantly, in group A there were remarkably less postoperative complications (39.44% vs. 73.81%) (p=0.000001), with a lower mortality rate (17.43% vs. 31.75%) (p=0,00253).

    Patients suffering from AGBDU are at high risk. They require urgent diagnostics and application of urgent endoscopic intervention procedures. The results prove that, in time, the treatment of this serious condition has considerably improved, but that the percentage of morbo-mortality is still above those presented elsewhere in the world. Proper choice of endoscopic techniques, pre- and postoperative techniques, appropriate surgical moment and approach, along with an application of worldwide-recognized standards of AGBDU treatment allow for obtaining better results in the treatment of this disease.

    Key words: duodenal ulcer, gastric ulcer, hemorrhage, bleeding