[Surgical treatment of massive rebleeding after gastrectomy for bleeding gastroduodenal ulcer].

OBJECTIVE

To summarize the reoperation experiences in treatment of massive rebleeding after subtotal gastrectomy for bleeding gastroduodenal ulcer.

METHODS

From 1980 to 2002, clinical data of 26 cases with massive rebleeding after subtotal gastrectomy for bleeding gastrorenal ulcer were analyzed retrospectively.

RESULTS

Preoperative gastroscopy was performed in 6 cases, intraoperative gastroscopy in 11, and preoperative superselective angiography in 2 cases. Eleven cases with left ulcer or post- bulb ulcer bleeding underwent resection of the left ulcer or longitudinal incision of the duodenal descending part and direct hemostasis. Thirteen cases with anastomotic stoma bleeding underwent local suture hemostasis or resection of the stoma plus Billroth II or Roux- en- Y gastrojejunostomy. Two cases with gastric bleeding received reexcision of the stomach remnant. Twenty- four cases (92.3% ) were cured and 2 cases (7.7% ) died of gastric bleeding.

CONCLUSION

Preoperative superselective angiography and intraoperative gastroscopy are beneficial to clarify the bleeding position and causes for massive rebleeding after gastrectomy. It is very important to select proper operative method to prevent postoperative rebleeding.