Surgical approaches to the treatment of complicated ulcers of the stomach and duodenum

Abstract

Surgical treatment of combined complications of peptic ulcer disease of the stomach and duodenum currently remains a complex and not fully resolved problem in abdominal surgery. Algorithms, surgical approaches and tactics of surgical treatment of patients with multiple combined complications have not been developed. The relative number of patients with a combination of complications has increased and is accompanied by significant mortality. The aim was to improve the results of surgical treatment of complicated gastroduodenal ulcers. The presented materials are the results of the analysis of the surgical treatment of patients with complicated gastroduodenal ulcer for the period from 2000 to 2022, which was carried out on the basis of the Kyiv City Clinical Hospital No.12 (Gastro Intestinal Bleeding Center of the city of Kyiv). 395 patients operated on for complicated gastroduodenal ulcers (combination of 2 or more complications) were analyzed. By time period, all patients were divided into 2 periods: group A (2000–2014) – 209 patients, group B (2015–2022) – 186 patients. Of which 299 (75.7%) patients had a combination of two complications in different combinations, 88 (22.3%) patients had a combination of three complications, and the remaining 8 (2.3%) had four complications. Gastrointestinal bleeding was observed in 164 (41.5%) of 395 patients, and ulcer perforation complications were observed in 353 (89.4%) patients. 352 (89.1%) emergency operations were performed, 43 (10.9%) early-term operations. The use of modern measures of endoscopic hemostasis made it possible to operate on patients with EDP, and their share increased 2.6 times (from 13 (6.2%) to 30 (16.1%)) and made it possible to perform radical operations in most cases (from 174 (83.2%) to 182 (97.8%)) both organ-preserving and organ-sparing. The total mortality in group A was 21 cases per 209 patients (10.1%), and in group B it decreased to 12 cases per 186 operated (6.5%). The highest rate of complications and mortality is associated with gastric resection – 42.9% (3 out of 7 patients). The lowest rate of mortality was among patients who underwent OSO, 3.3% (8 out of 245 operated on). Keywords: complicated gastroduodenal ulcer, perforation, bleeding, stenosis, penetration, early delayed period.