Priorities and innovations in the treatment of urgent complications of gastric and duodenal ulcer in urban and regional general surgical hospitals

The experience of the city and two district general surgical hospitals in providing emergency care to patients with urgent complications of peptic ulcer of the stomach and duodenum in the periods 2003-2005 and 2022-2025 was subjected to a comparative analysis. The priority methods of treatment of perforated gastroduodenal ulcers were open operations from laparotomy access with perforation removal. Laparoscopic technologies are of limited use, the reasons for this are morphological factors of localization and the state of the ulcerative process, as well as organizational and economic (low equipment of medical institutions with appropriate equipment and insufficient training of personnel). Complications decreased by 1.2 times, but mortality increased from 5.4% to 7.3%, i.e. the rejection of the radical anti-ulcer stage did not improve the situation. In the surgery of ulcerative bleeding, the main tactical principle is the priority use of endoscopic methods to stop bleeding. Injection or contact thermal degradation is used as the first stage, and if ineffective, remote argon plasma coagulation is used. The effectiveness of endoscopic "hemostasis" was 96.1%, while the effectiveness of repeated photocoagulation procedures was noted in patients with a high risk of recurrence or manifestation of bleeding, which reduced surgical activity to 5.6%. The priority was open surgical interventions in the amount of excision or stitching of the ulcer (42.4%). Radical, resection methods or duodenoplasty (56.9%). Postoperative complications and mortality were 72.1% and 67.0%, due to comorbid patients with a high degree of surgical and anesthetic risk, but the overall mortality decreased from 7.7% to 3.9%, which indicates positive trends in the treatment of patients with ulcerative gastroduodenal bleeding. To facilitate the performance of operations in the subhepatic and central subdiaphragmatic spaces, as well as for a better examination of the gastric cavity during gastrotomy, the use of multifunctional LED lighting instruments is recommended.

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