HYBRID METHOD OF INTRAGASTRIC HEMOSTASIS OF ULCERATIVE GASTROINTESTINAL BLEEDING IN PATIENTS WITH MORBID OBESITY

Abstract

Resume. Introduction. The problem of ulcer bleeding of the gastroduodenal zone, despite progress in treatment, still poses a significant threat to the population of Ukraine. It is a recognized fact that although the incidence of peptic ulcer disease and the frequency of ulcer bleeding are constantly decreasing, their high mortality, which is 11-25%, still remains. Surgical stoppage of bleeding is an effective but risky method of treatment in morbidly obese patients, as mortality after laparotomy is almost twice as high in them as in patients with normal weight, 54.5 % versus 30.5 %. Against this background, laparoscopic surgical treatment looks more promising, since studies show that weight does not affect mortality when performing interventions using this technique. However, there are almost no cases of laparoscopic treatment of ulcerative gastrointestinal bleeding described in the literature. Purpose: to improve the results of laparoscopic surgical treatment of ulcerative gastrointestinal bleeding in patients with morbid obesity. Materials and methods. In the course of the study, a statistical analysis of the results of the treatment of bleeding from a peptic ulcer of the gastroduodenal zone was performed in 16 (66.7 %) patients who underwent open surgery, and in another 8 (33.3 %) patients who underwent a hybrid technique. Research results. The hybrid method demonstrated a 49.4 % shorter operative time and 65.9 % faster access to the bleeding site. Also, the need for revision or puncture aspiration under ultrasound control of the extraperitoneal wound was necessary in 9 patients (56.3 %) with an open technique and was not present in the group of hybrid treatment. Mortality in the control group was 18.5 %, while it was completely absent in the main group. Conclusions. The use of a hybrid method of stopping bleeding from a peptic ulcer in patients with morbid obesity is safe and has a number of advantages in comparison with an open one, in particular: a reduction in the duration of surgical intervention by 46.9 %, achievement of early mobility of patients - already on the first day and discharge from the clinic — on the 4th day, a significantly lower frequency of postoperative wound infectious complications, as well as a decrease in the level of mortality.