Surgical conservative treatment of recurrent bleeding duodenal ulcer.
OBJECTIVE
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.


METHODS
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%).


CONCLUSIONS
Surgical CT of BDU with continuous PPI is effective, with a low rate of rebleeding. The standard use of vagotomy-antrectomy is questionable.
Brehant
O
O
Departments of Digestive Surgery, University Hospital, University of Picardie, Place Victor Pauchet, 80054 Amiens 01, France.
Duval
H
H
Dumont
F
F
Fuks
D
D
Deshpande
S
S
Verhaeghe
P
P
Yzet
T
T
Bartoli
E
E
Brazier
F
F
Mauvais
F
F
Lobjoie
E
E
Dupas
J L
JL
Regimbeau
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004381:Duodenal Ulcer / Q000150:complications* / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D019233:Retreatment; D013536:Suture Techniques; D055815:Young Adult
D054328:Proton Pump Inhibitors