Risk factors in non-variceal and non-malignancy upper gastrointestinal system bleedings in the patients undergoing surgery

Abstract

Purpose: Despite the advances in treatment methods, upper gastrointestinal system bleeding still appears as a serious problem. In this study, we aimed to investigate the effective risk factors on mortality in the patients that underwent surgery due to non-variceal and non-malignant bleeding from upper gastrointestinal tract, which was not responding to endoscopic management.

Materials and Methods: Between 1997 – 2010, 74 patients who underwent surgery due to upper gastrointestinal system bleeding were analyzed retrospectively. The bleeding due to the malignancy and varices were excluded.

Results: There were 81 (82.4%) male and 13 (17.6%) female patients, with a mean age of 51.8 years. The common complaint at the admission was melena (50%). Cardiovascular diseases were the most common comorbidity which were seen in 19 (27.4%) cases. Shock symptoms were seen in 48 (64.9%) patients. Forrest 1a was the most common bleeding form, which was detected endoscopically in 34 (51.5%) patients. Duodenal ulcer was detected in 56 (75.7%) patients. Commonly performed surgical procedure was bilateral truncal vagotomy and pyloroplasty with the ligation of gastroduodenal artery. Morbidiy rate was 24.3% and common one was pulmonary complication. Mortality occured in 15 (24.3%) patients. There was no mortality in the patients with Rockall score <5, while the mortality rate was 25.4% in the others. Elder age, male gender, comorbid disease, shock, low hemoglobin value, blood transfusions and high Rockall score were effective risk factors on mortalilty.

Conclusion: Early surgery and close cooperation between gastroenterologists and surgeons may be benefical at the treatment of high risk upper gastrointestinal bleeding, except variceal and malignancy bleedings.