Surgical treatment of acute complicated duodenal ulcers

Abstract

Complications of peptic ulcer of the stomach and duodenum are an integral part of urgent abdominal surgery. This especially applies to complications of duodenal ulcers (DU), which, in turn, is associated with a combination of several complications and problems with the choice of surgical tactics for their treatment. This is supported by postoperative mortality rates, which remain high and range from 15.0% to 68.0% according to various sources. The aim was to improve the results of treatment of complicated duodenal ulcers. The results of the analysis of surgical treatment of acutely complicated duodenal ulcers (combination of 3 and/or 4 combined complications) for 2 periods are presented: 1st – from 2000 to 2014 (group A) – 69 patients; 2nd – from 2015 to 2022 (group B) – 50 patients. 119 (100.0%) patients were operated on for complicated duodenal ulcers, of which 101 (84.9%) patients had a combination of three complications, and 18 (15.1%) – four complications. Out of 119 patients, 106 (89.1%) had bleeding complications. Complications of ulcer perforation in 53 (44.5%). Based on the obtained analysis data, there is a steady trend towards an increase in the rate of organ-preserving operations by 1.62 times (from 50.7% to 82%), a decrease in the number of gastric resections by 2.7 times (from 15.9 % to 6%). The number of performed organ-sparing operations was relatively stable: in group A – 15 (21.7%), in group B – 10 (20%). The use of modern measures of endoscopic hemostasis made it possible to implement a system of preparing patients for surgery, to operate on patients in the early delayed period, and their share from the first period to the second increased by 3.2 times (from 5.7% to 18.3%). The number of patients who underwent emergency surgery with ulcer perforation and bleeding as combined complications decreased in the second period compared to the first by 2.8 times, which is associated with the widespread use of mo­dern proton pump inhibitors in the conservative treatment of DU. Actively individualized tactics and the use of developed algorithms for choosing the type of surgical intervention made it possible to reduce the mortality rate by almost 2 times: from 16.8% in the first period (group A) to 8.9% in the second period (group B). Keywords: perforation, bleeding, stenosis, penetration, vagotomy, gastric resection.