EMERGENCY HEMOSTATIC SURGERY FOR HEMORRHAGIC GASTRIC ULCER

概要

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Endoscopic hemostasis is the treatment of first choice for bleeding gastric ulcer. Endoscopic submucosal or perivascular ethanol injection and microwave coagulation are widely used. These methods of endoscopic hemostasis permit control in most bleeding cases. In some cases however, endoscopic hemostasis is impossible or re-bleeding occurs after endoscopic hemostasis. In these cases, distal gastrectomy is the most common treatment for both control of peptic ulcer and for control of bleeding. Recently, medical control of peptic ulcer has become routine and effective, so distal gastrectomy is considered to over invasive for the treatment of bleeding ulcer. In the standpoint of view, we have concluded that reliable hemostasis by direct suture is necessary to manage theses patients. For this procedure, mini-laparotomy (about 5cm length) and mini-gastrectomy is satisfactory, and it is very important for surgical invasion.<BR>Since 1994, We have encountered 12 patients in whom endoscopic hemostasis had failed and mini-laparotomic operation was performed. The average operating time was 53 minutes and average length of hospital stay was 12 days. All of the patients have been discharged and no evidence of recurrence. We therefore conclude that mini-laparotomic direct suture hemostasis is the treatment of first choice in bleeding gastric ulcer in which endoscopic management has failed.
北関東医学会の論文