Surgical treatment of acute complicated duodenal ulcer

Abstract

The aim. To analyze treatment approaches and tactics and improve acutely complicated duodenal ulcers (DU) treatment results. Materials and methods. The results of the analysis of the surgical treatment of acutely complicated duodenal ulcers (a combination of 3 and/or 4 combined complications) are presented for 2 periods: the 1st (2000–2014) years (group A) – 47 patients, the 2nd (2015–2021) years (group B) – 34 patients. Results. 81 (100 %) patients were operated on for acutely complicated duodenal ulcers, of which 68 (84.3 %) patients had a combination of three complications, and 13 (15.7 %) had four complications. Out of 81 patients, 72 had bleeding complications, which is 89.3 %. Complications of ulcer perforation – in 36 patients, 44.7 % of all other complications. Based on the obtained analysis data, there is a steady trend towards an increase in the share of organ-sparing operations (OSO) by 1.6 times (from 50.9 % to 81.4 %), a decrease in the number of gastric resections (GR) by 2.9 times (from 14.9 % to 4.9 %) and palliative operations (PO) by 3.2 times (from 15.8 % to 4.9 %) with a relatively stable number of performed organ-preserving operations (OPO): in group A – 17 (24 .6 %) interventions, in group B – 4 (21.1 %). Conclusions. The use of modern measures of endoscopic hemostasis made it possible to adequately prepare and operate on patients in the delayed period, and their share from the first period to the second increased by 2.9 times. 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 2.5 times, which is associated with the widespread use of modern proton pump inhibitors (PPIs) in the conservative treatment of DU. The number of complications and mortality of this cohort of patients also significantly decreased due to the use of endoscopic hemostasis methods, making it possible to stabilize and prepare patients on the operating table. According to the analysis results, it became known that the chosen active-individualized tactics and the use of developed algorithms for choosing the type of surgical intervention made it possible to achieve a stable level of postoperative mortality at 8.1 %.