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[Treatment of complicated peptic ulcer: personal experience]
1Dipartimento di Emergenza e Accettazione, Unità Operativa di Chirurgia d'Urgenza, Policlinico S. Orsola-Malpighi, Università degli Studi di Bologna, Bologna, Italy. acaira@orsola-malpighi.med.unibo.it
Insights
Despite advances in medical and endoscopic treatments for peptic ulcers, surgery remains essential for complicated cases like perforation and hemorrhage, especially when risk factors are present.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Internal Medicine
Context:
- Peptic ulcer disease (PUD) management has evolved with pharmacological and endoscopic interventions.
- However, the incidence of PUD complications remains a significant clinical challenge.
- Effective control of gastric secretion has improved PUD management but not its complication rates.
Purpose:
- To retrospectively evaluate the role of surgery in managing complicated peptic ulcers (hemorrhage and perforation).
- To assess the outcomes and necessity of surgical intervention in a cohort of 153 patients over six years.
Summary:
- A retrospective study analyzed 153 patients with complicated peptic ulcers (hemorrhage or perforation).
- Hemorrhage, a common PUD complication, rarely necessitates surgery due to successful medical and endoscopic therapies.
- Surgery was required in 17.2% of cases, with high operative mortality noted in hemorrhage patients due to risk factors.
- All perforated peptic ulcer cases in the study underwent surgical treatment.
Impact:
- Surgical intervention remains critical for perforated peptic ulcers.
- High operative mortality associated with surgical treatment for hemorrhage underscores the need for careful patient selection.
- This study reaffirms surgical treatment as the primary approach for complicated peptic ulcer disease despite therapeutic advancements.
Background:
The availability of drugs which can effectively inhibit gastric secretion allowed the control of the peptic disease in almost all the patients, but the incidence of complications is substantially unchanged.
Methods:
In the present study, we performed a retrospective evaluation of 153 patients treated for complicated peptic ulcer (hemorrhage and perforation) in the last 6 years. Hemor-rhage is a common onset of the peptic disease and it rarely requires a surgical treatment, because medical and endoscopic therapies are successful in a high number of patients.
Results:
Surgery was necessary in 17.2% of the cases in the group of patients studied.
Conclusions:
Our experience confirms the high operative mortality in the patients who underwent surgery for hemorrhage related to complicated peptic ulcer because of the frequent presence of several risk factors. Surgical therapy is the main procedure of treatment of perforated peptic ulcer and in the group of patient examined all the cases of perforation underwent surgical operation. In conclusion, despite the progress of pharmacological and endoscopic therapies, surgical treatment is the best therapy of complicated peptic ulcer.