What is the most appropriate surgical procedure for a bleeding duodenal ulcer? The best option is simple oversew of the bleeding ulcer. Control of the ulcer bed is attained by performing a duodenotomy with direct ligation of the bleeding vessel or complete plication of the ulcer bed. Three-point suture ligation takes place in the superior, …
What are the surgery options for control of a bleeding gastric ulcer? The best option is excision. Bleeding gastric ulcers require excision and biopsy to rule out malignancy. Small gastric ulcers (less than 2 cm) can usually be excised easily and safely, with the addition of an ulcer operation for patients who are acid hypersecretors. Large …
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Classic indications for operation for rebleeding after endoscopic therapy After two attempted endoscopic therapeutic interventions for a bleeding peptic ulcer, patients who have already required six units of blood should be strongly considered for surgical intervention. In general, the indications for surgical treatment of a bleeding peptic ulcer are: Hemodynamic instability as a result of …
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In patients with GI bleeding caused by PUD, what are the predictors for rebleeding in the hospital? What is the Forrest classification? Hemodynamic instability (systolic blood pressure < 100 mm Hg, heart rate > 100-110 beats per minute) Large ulcer size (> 1-2cm) Ulcer location (posterior duodenal wall, high lesser curvature) Active bleeding during endoscopy …
Role for laparoscopy in the management of perforated PUD and the indications for conversion to an open operation The surgical goals in the laparoscopic management of a perforated peptic ulcer are similar to those of open surgical management: Repair of the perforation Copious irrigation of the abdominal cavity Addition of a definitive ulcer operation, which …
What are the major risk factors for mortality in the surgical treatment of perforated PUD? Severe comorbidities Perforation present for longer than 24 hours Hemodynamic instability on presentation Patients with one of these risk factors have a mortality rate of approximately 10%; with two risk factors, the mortality rate increases to 46%. Patients with all …
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What is the preferred surgery for treatment of a perforated duodenal ulcer? The preferred operation is a simple patch (Graham patch) of the perforation, especially in the setting of shock or in patients with multiple comorbidities undergoing an emergent operation, when prolonged operative time can be detrimental. In patients who have undergone medical therapy to …
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