外科ジャーナル

Current Surgical Therapy of Gastroduodenal Ulcer Disease

Abstract

Radu-Mihail Mirica, Silviu Morteanu, Alexandra Banica, Bogdan Stan-Iuga, Simon Msika and Mircea Beuran

Introduction: Peptic ulcer is still a very common pathology which exposes the patient to life-threatening complications. This retrospective observational study aims a comparison between current different therapeutic strategies and the advantages and disadvantages in order to improve them.

Material and Method: The study group is composed of 108 patients, 96 hospitalized in Emergency Hospital Bucharest (EHB) and 12 patients hospitalized in Louis-Mourier Hospital, Paris, for the period of 3 years. Were included in the study patients with peptic ulcer and with complications of peptic ulcer treated surgically.

Results: The most common location of peptic ulcer identified in our study was the anterior bulbar duodenum wall. The posterior lessions were penetrating in the pancreas in 78.56% of cases (correlation coefficient=0.034, p=0.002). The surgical treatment strategy adopted in most cases was the suture of the ulcer with or without epiplonoplasty (in 37.5% of cases in EHB and in all cases in Louis-Mourier Hospital), the differences were in the approach technique: most interventions in EHB were performed by laparotomy. The surgical management of perforation was in most cases gastrectomy followed by bulbantrectomy. The operation of gastrectomy was done at a rate of 65.52% by laparotomy (p=0.001). Regarding the reconstruction of digestive tract, most anastomoses were performed manually. They are mainly gastro-duodeno anastomosis Pean (37%) because it provides a physiological continuity.

Conclusions: Therapeutic management adopted in the two clinics were largely similar, mention the status of population-related differences, socio-economic status and the dinamics of risk factors (NSAID therapy, the incidence of HP, food etc..).