Algorithm for surgical treatment of gastroduodenal ulcer with multiple combined complications
DOI:
https://doi.org/10.30978/GS-2023-3-40Keywords:
gastroduodenal ulcer, multiple combined complications, peritonitis, gastric resection, organ-saving operations, early delayed periodAbstract
Surgical management of gastroduodenal ulcers (GDU) and multiple combined complications (MCC) remains a relevant, complex and unresolved issue. There are currently no well‑defined algorithms, strategies, or surgical procedures for the treatment of gastroduodenal ulcers accompanied by a variety of complications.
Objective — to improve the results of surgical treatment and reduce the mortality of patients with GDU and MCC by implementing a surgical treatment algorithm.
Materials and methods. The results of surgical treatment of patients with complicated GDU for the period 2000—2022 are presented. A total of 395 (100.0%) patients with GDU accompanied by MCC (a combination of two or more complications) were operated on. There were 52 (13.16%) patients with gastric ulcer perforation and 301 (76.2%) patients with duodenal perforation. A combination of two complications was noted in 299 (75.69%) patients, three — in 88 (22.28%) patients, and four — in 8 (2.03%) patients.
Results. A total of 352 (89.11%) operative interventions were performed in an emergency, 43 (10.88%) were performed in the early delayed period (EDP). The implementation of a new algorithm of surgical treatment in the main group and the use of modern measures of endoscopic hemostasis made it possible to increase the rate of operated patients in EDP by 2.6 times, and reduce the mortality rate from 10.14% to 6.45%. The highest rate of mortality is associated with gastric resection in patients with GDU and MCC — 3 (42.87%) out of 7 patients. The lowest mortality rate was among patients who underwent one of the types of organ‑saving surgery — 7 (2.86%) patients out of 245 operated on in this group.
Conclusions. The implementation of the algorithm for providing surgical care to patients with GDU accompanied by MCC made it possible to reduce intraoperative mortality from 10.14% to 6.45%. The use of modern means of endoscopic hemostasis made it possible to stabilise, adequately prepare, and operate patients in EDP, which is confirmed by the increase of this indicator in the main group by 2.6 times. The highest mortality rate was in patients who underwent gastric resection and was 42.87%.
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