Surgical approach in severe bleeding peptic ulcer

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Medicine

Background:

• Hospitalizations and surgeries for uncomplicated peptic ulcers have declined.
• However, operations for bleeding peptic ulcers have increased, highlighting hemorrhage as a significant complication with high mortality.
• Emergency surgery for bleeding peptic ulcers carries a substantial mortality rate (10-20%).

Purpose of the Study:

• To evaluate the impact of endoscopic hemostasis and surgical interventions on mortality rates in patients with bleeding peptic ulcers.
• To determine optimal surgical strategies for different risk groups and ulcer types.

Main Methods:

• Review of trends in peptic ulcer surgery and complication rates.
• Analysis of outcomes associated with endoscopic hemostasis and various surgical procedures (truncal vagotomy, pyloroplasty, proximal gastric vagotomy, partial gastrectomy).
• Risk stratification of patients based on hemorrhage recurrence and mortality.

Main Results:

• Endoscopic hemostasis reduces hospital mortality by decreasing rebleeding and the need for emergency operations.
• Emergency surgery is indicated for active hemorrhage refractory to endoscopic treatment.
• Combination of endoscopic hemostasis and early elective surgery benefits selected high-risk patients.
• Truncal vagotomy and pyloroplasty are recommended for poor-risk patients with duodenal ulcer hemorrhage.
• Partial gastrectomy is favored for gastric ulcers due to reduced recurrence and malignancy risk.

Conclusions:

• Endoscopic hemostasis is crucial in managing bleeding peptic ulcers, improving outcomes by reducing emergency operations.
• Surgical intervention should be carefully selected based on patient risk factors and ulcer characteristics.
• For gastric ulcers, more radical procedures like partial gastrectomy are beneficial for managing hemorrhage and malignancy risk.