Minimal operations

In 2 patients with duodenal ulcer rebleeding appeared in the later stages at 11 days of initiation of treatment. He was stopped endoscopically, patients assigned to injectable forms of proton pump inhibitors. Favorable outcome.

Thus, at this stage has changed surgical tactics in case of recurrent bleeding: if earlier, according to the canons of surgery, rebleeding in hospital is an absolute indication for urgent surgery, to date, this tactic should be reviewed:

* Rebleeding in the first three days is associated with brand viagra online inadequate endoscopic hemostasis and properly selected patient management in high risk groups for the localization of ulcers in the stomach. In this case, really need to address the issue of urgent surgical intervention, as hopes of endoscopic hemostasis are unjustified;

* Rebleeding at 4-day 6 is associated with inadequate antisecretory therapy and the growth of multiple organ failure in elderly patients. Tactics of treatment in this case is individual, depending on the aggressiveness of the disease, but preference should be given to endoscopic methods of hemostasis and increased antisecretory therapy;

* All late rebleeding after 10 days of duodenal ulcers associated with inadequate antisecretory therapy and can be treated conservatively. It should be noted that the nature of the treatment of gastrointestinal bleeding depended on the localization of ulcers, so that stomach ulcers were operated in 2 times more patients than in duodenal ulcer.

This is due to the fact that peptic ulcer worse amenable to standard schemes of conservative therapy, gastrointestinal bleeding, the need for surgery occurs in every fourth patient in the elderly. Indeed, the secretory function of gastric ulcer patients "elderly" age lowered, Hp-negative ulcers occur much more frequently, which leads to inefficiency of standard schemes antiulcer quadrotherapy. More common forms of atrophic generic levitra gastritis, which leads to the large size of ulcers and difficulty of endoscopic hemostasis. Therefore, in solving practical problems of surgical treatment of peptic ulcer disease should take into account significant differences in the pathogenesis of gastric and duodenal ulcers.

Declined by nearly 10 times the number of such minimal operations for ulcer bleeding, as suturing wounds. These operations were not given the anticipated hemostatic effect: rebleeding after flashing ulcers - 55,5%, while the fatality rate - 47,2%.

At the present time, given the objective assessment of the severity of the condition of elderly patients by scores MODS and APACHE II, we try to perform radical surgery. Due to new tactics and an objective assessment of the severity of the patients is almost 2-fold increase in the number of conservative surgery: 56% from 33% in 1990-2000. Do not change the percentage of resection of operations - 43% in 1990-2000. and 42% in 2001-2008. this is due to the fact that most surgical interventions for patients with gastrointestinal bleeding is satisfied with the localization of ulcers in the stomach. However, if you had a group of elderly patients in all cases, an extensive resection with a mortality rate 13,2%, in the last 10 years, we prefer economical resection with vagotomy.

Change the surgical treatment of this complication in elderly patients has led to a decrease in postoperative mortality from 15.8% in 1990-2000. to 5,8% in 2001-2008. and overall mortality from 15.8 to 9.6% and corresponds to the global trend.

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