Risk factors in surgery of gastroduodenal ulcer disease in patients with schistosomal portal hypertension.

The present study was conducted to determine the risk factors associated with surgical treatment of peptic ulcer disease (PUD) in patients with schistosomal hepatic fibrosis (SHF). The medical records of 32 patients treated at the Department of Surgery, Alexandria Faculty of Medicine between 1984 and 1994 were reviewed and data were analyzed. Twenty-five patients were male and seven were female, with a mean age of 43.3 +/- 24. Fifteen patients belonged to Child A and 13 to Child B. Twenty-one patients were variceal non-bleeders and 11 were bleeders. The ulcer was pyloric or duodenal in 30 patients and gastric in only two. Twenty-four patients were operated upon electively mostly for pyloric obstruction (n = 15) and eight patients emergently; five for perforation and three for bleeding. Hepatic insufficiency, renal function impairment and gastrointestinal bleeding were the most detrimental postoperative complications that occurred, either alone or in combination, in 13 patients (40.6%). Eight patients died (25%) of liver failure (n = 5), gastrointestinal bleeding (n = 2) and multiple systems organ failure (n = 1). Urgency of the operation and Child B were of significance for predicting mortality in contrast to age, sex, liver size, bleeding varices and ulcer location. Based on these data, it may be concluded that 1) operations for PUD in patients with schistosomal portal hypertension are expected to have high postoperative morbidity and mortality; 2) mortality rate significantly increases by emergency operations, presence of postoperative complications and in modified Child B patients; 3) Liver function must be optimized preoperatively; and 4) the most simple and expeditious procedure must be performed to minimize postoperative complications and hepatic decompensation.