Abstract
Background
The treatment of a bleeding chronic posterior duodenal ulcer, with bleeding recurrence or persistence despite endoscopic therapy, requires surgical treatment and constitutes a challenge for the surgeon; furthermore such chronic ulcers are often wide and sclerotic, so the surgeon needs to avoid the risk of recurrent bleeding if conservative surgery is applied. If radical surgery must be performed, the greater risk involves duodenal leakage, hepatic hilar injury, or pancreatic injury. This study aimed to evaluate the efficacy and complications arising from a surgical procedure, described by Dubois in 1971 (Gastrectomy and gastroduodenal anastomosis for post-bulbar ulcers and peptic ulcers of the second part of the duodenum. J Chir 101:177–186). This operation involves antroduonectomy with gastroduodenal anastomosis. It is similar to a Billroth I gastrectomy but without dissection of the ulcer.
Materials and methods
We retrospectively studied the medical data of patients who underwent this procedure for the treatment of bleeding chronic posterior duodenal ulcers during the past 20 years.
Results
There were 28 such patients admitted to our institution for emergency surgery, who went on to be treated by the Dubois procedure. Ulcerous disease was efficiently treated without rebleeding or duodenal leakage. The mortality rate was 17%; most deaths resulted from medical failure in older patients suffering from massive bleeding. The rate of medical complications reached 21%. Surgical complications developed in 14% of patients.
Conclusions
The Dubois antroduodenectomy is a safe and effective surgical procedure for the treatment of bleeding chronic duodenal ulcers. The number of fatal outcomes among patients with this condition remains high, particularly in older and vulnerable patients experiencing massive bleeding.
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References
Ohmann C, Imhof M, Roher HD (2000) Trends in peptic ulcer bleeding and surgical treatment. World J Surg 24:284–293
Gisbert JP, Legido J, Castel I et al (2006) Risk assessement and outpatient management in bleeding peptic ulcer. J Clin Gastroenterol 40:129–134
Millat B, Hay JM, Valleur P et al (1993) Emergency surgical treatment for bleeding duodenal ulcer: over-sewing plus vagotomy versus gastric resection, a controlled randomized trial. World J Surg 17:568–574
Choudari CP, Rajgopal C, Elton RA et al (1994) Failure of endoscopic therapy for bleeding peptic ulcer: an analysis of risk factors. Am J Gastroenterol 89:1968–1972
Kyser S, Binyamini Y, Melki Y et al (1997) Comparative study of the early postoperative course and complications in patients undergoing Billroth I and Billroth II gastrectomy. World J Surg 21:763–766
Dubois F (1971) Gastrectomy and gastroduodenal anastomosis for post-bulbar ulcers and peptic ulcers of the second part of the duodenum. J Chir 101:177–186
Monig SP, Lubke T, Baldus SE et al (2002) Early elective surgery for bleeding ulcer in the posterior duodenal bulb. Own results and review of the literature. Hepatogastroenterology 49:416–418
Millat B, Fingerhut A, Frederic B (2000) Surgical treatment of complicated duodenal ulcers: controlled trials. World J Surg 24:299–306
Branicki FJ, Boey J, Fock PJ et al (1990) Bleeding duodenal ulcer. Ann Surg 211:411–418
Burch JM, Cox CL, Feliciano DV et al (1994) Management of the difficult duodenal stump. Am J Surg 162:522–526
Ripoll C, Banares R, Beceiro I et al (2004) Comparison of transcathter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol 15:447–450
De Wispelaere JF, De Ronde T, Trigaux JP et al (2002) Duodenal ulcer hemorrhage treated by embolization: results in 28 patients. Acta Gastroenterol Belg 65:6–11
Holme JB, Nielsen DT, Funch-jensen P et al (2006) Transcathter arterial embolization in patient with bleeding duodenal ulcer: an alternative to surgery. Acta Radiol 47:244–247
Meyer C, Rohr S, De Manzini N et al (1994) Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer. World J Surg 18:286–288
Malheiros CA, Moreno CH, Rodrigues FC et al (1998) Finsterer-Bancroft operation: an option for the treatment of difficult duodenal ulcers. Int Surg 83:111–114
Brehant O, Duval H, Dumont F et al (2008) Surgical conservative treatment of recurrent bleeding duodenal ulcer. Hepatogastroenterology 55:1327–1331
De La Fuente SG, Khuri SF, Schifftner T et al (2006) Comparative analysis of vagotomy and drainage versus vagotomy and resection procedures for bleeding peptic ulcer disease: results of 907 patients from the Department of Veterans Affairs National Surgical Quality Improvement Program database. J Am Coll Surg 202:78–86
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We thank Murielle Dovillaire who provided us with the two figures.
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Guinier, D., Destrumelle, N., Denue, P.O. et al. Technique of Antroduodenectomy Without Ulcer Excision as a Safe Alternative Treatment for Bleeding Chronic Duodenal Ulcers. World J Surg 33, 1010–1014 (2009). https://doi.org/10.1007/s00268-009-9953-1
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DOI: https://doi.org/10.1007/s00268-009-9953-1