Preoperative and postoperative management of elderly and old-aged patients with gastoduodenal ulcer bleeding

Objective. The aim of the paper is to improve the results of surgical treatment of elderly and old-aged patients with gastroduodenal ulcer bleeding (GDUB) using local treatment with adhesive applications, controlled novocaine sympathetic denervation (CNSD) and magnetic therapy. Material and Methods. 223 patients aged 60 years and older with GDUB were examined. 159 (71 %) patients were operated on. 42 patients were exposed to CNSD both in pre- and postoperative period and to magnetic therapy («Magniter») only in postoperative period. To prevent postoperative pancreatitis (PP), gastrostasis, and reduction in the incidence of postoperative enteroparesis 40 patients were exposed to CNDS in preoperative period. In case of postoperative complications CNDS was used in its complex treatment. In conservative treatment of GDUB, when sustainable local endoscopic adhesive hemostasis was achieved, 29 patients were administered anticoagulation reversal, and 22 patients were treated without it. Results. Application of CNSD 30 minutes before the operation and during the first three to five days after surgery reduced the incidence of PP by 35 % and incidence of dynamic ileus by 55 %. CNSD and magnetic therapy in complex treatment of elderly patients (more than 60 years old) with GDUB can accelerate the positive dynamics of the basic clinical and laboratory parameters, and to reduce postoperative complications by 50 %. Such method of treatment helps to reduce postoperative lethality by 44 %, and duration of treatment by 5.7 days. Conclusions. Elderly patients with GDUB demonstrate more significant dysfunction of blood coagulation. Treating elderly and old-aged patients without systemic hemostatic drugs while providing a stabile arrest of bleeding with local adhesive endoscopic hemostasis is pathogenetically justified and can reduce the risk of thromboembolic complications.