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[Bleeding gastroduodenal ulcer: results of surgical management]
N Cheynel1, F Peschaud, O Hagry
1Service de chirurgie digestive, thoracique et cancérologique, CHU du Bocage, 2, boulevard Maréchal-de-Lattre-de-Tassigny, 21034 Dijon, France.
Aim Of The Study:
The aim of this retrospective study was to report the mortality and morbidity after surgery for bleeding peptic ulcer while the population is aging and while the medical treatment and endoscopic procedures are improving.
Patients And Methods:
This retrospective study between 1994 and 1999 included 49 patients, 15 women, 34 men, aged 72 +/- 14 years. Patients were separated into three groups: ten with uncontrollable haemorrhages, 28 with recurrent haemorrhages and 11 with persistent haemorrhages. These patients were classified ASA II (n = 6), ASA III (n = 20), ASA IV (n = 21) and ASA V (n = 2). The surgical procedures for gastric ulcers (n = 5) were resection-oversewing (n = 2) or partial gastric resection (n = 3). The surgical procedures for duodenal ulcers (n = 44) were oversewing (n = 30), partial gastric resection (n = 10) or exploratory duodenotomy (n = 4).
Results:
The overall postoperative mortality rate was 20.4% (10/49). The mortality rate was 40% (4/10) in patients with massive haemorrhage, 7% (2/28) in patients with recurrent haemorrhage, and 36% (4/11) in patients with persistent haemorrhage. There was no significant difference in the mortality rate in relation to the surgical procedures. The morbidity rate was 45%, including three bleeding recurrences after suture and three duodenal leakages after partial gastric resection.
Conclusion:
The morbidity and mortality rate after surgery for bleeding peptic ulcer is still high. Recurrent haemorrhages don't worsen the prognosis. Delayed surgery for persistent haemorrhage is associated with a severe prognosis.