Surgical conservative treatment of recurrent bleeding duodenal ulcer.

作者信息

Brehant O, Duval H, Dumont F, Fuks D, Deshpande S, Verhaeghe P, Yzet T, Bartoli E, Brazier F, Mauvais F, Lobjoie E, Dupas J L, Regimbeau J M

机构信息

Departments of Digestive Surgery, University Hospital, University of Picardie, Place Victor Pauchet, 80054 Amiens 01, France.

出版信息

Hepatogastroenterology. 2008 Jul-Aug;55(85):1327-31.

PMID:18795682

Abstract

BACKGROUND/AIMS: Endoscopic hemostasis and proton pump inhibitors (PPI) have decreased the incidence of rebleeding and reduced the need for surgery for bleeding duodenal ulcer (BDU). The gold standard surgical treatment of BDU remains vagotomy-antrectomy. Currently, no recommendation is made on the best procedure when emergency surgery is necessary. The aim of this study was to assess the results of a systematic conservative treatment (CT): under-running bleeding gastroduodenal artery (GDA) and ulcer suture through a duodenotomy with (CT+L group) or without (CT group) GDA double ligation along with continuous intravenous PPI.

METHODOLOGY

From 1995 to 2006, 22 consecutive patients (11 per group) underwent emergency surgery for BDU. Mean age was 63 +/- 18 years, ASA score 2.64 +/- 0.7. Ten patients (45%) presented collapse. Mean transfusion number was 11 +/- 9, number of therapeutic endoscopies 1.7 +/- 1, and Rockall score 6 +/- 2.

RESULTS

Overall, 2 patients (9%) had rebleeding and 5 patients (22%) died. No death was reported secondary to rebleeding. In the CT+L group, 9 patients (82%) had intravenous PPI, no patient had rebleeding and 2 patients died (22%).