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Bleeding duodenal ulcer--treatment strategy. A follow-up study
H J Gyrtrup1, T Orsnaes, J O Søndergaard
1Department of Surgery, Sundby Hospital, Copenhagen, Denmark.
Annales Chirurgiae Et Gynaecologiae
|January 1, 1987
Summary
Surgical ligation, pyloroplasty, and vagotomy for bleeding duodenal ulcers are largely unsuccessful, leading to high rates of recurrent bleeding and mortality. Alternative treatments like endoscopic electrocoagulation or modified surgery are recommended.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Medicine
Background:
- Duodenal ulcers are a common cause of upper gastrointestinal bleeding.
- Surgical intervention is sometimes required for persistent or severe bleeding.
- Previous surgical methods included ligation, pyloroplasty, and vagotomy.
Purpose of the Study:
- To evaluate the long-term efficacy of ligation, pyloroplasty, and vagotomy for bleeding duodenal ulcers.
- To identify alternative or improved treatment strategies for this condition.
Main Methods:
- A follow-up study was conducted on 40 patients previously treated with ligation, pyloroplasty, and vagotomy.
- Patient outcomes, specifically recurrent bleeding and mortality, were assessed.
Main Results:
- Recurrent bleeding occurred in 23% of patients (9 out of 40).
- Mortality from recurrent bleeding was high, affecting 78% of those with re-bleeding (7 out of 9).
- The studied surgical method demonstrated a high failure rate.
Conclusions:
- The combination of ligation, pyloroplasty, and vagotomy is an unsuccessful treatment for bleeding duodenal ulcers.
- Endoscopic electrocoagulation is recommended for hemostasis.
- If resection is too risky, ligation with medical vagotomy (H2-receptor antagonist) is a suggested alternative.