Transgastric surgery for posterior juxtacardial ulcers

A minimal and safe approach

Ricardo A.M. Camprodon, Reyad Al-Ghnaniem, Ricard Camprodon, Jon S Thompson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Hypothesis: A transgastric approach may be used succesfully for the treatment of posterior juxtacardial ulcers presenting with massive bleeding. Methods: Eight patients were admitted during a 6-year period with acute massive upper gastrointestinal bleeding caused by posterior juxtacardial ulcers. All patients had signs of profound hypovolemic shock, and initial endoscopic control was achieved in 3 patients. They all underwent surgery after endoscopy. At operation, the ulcer was approached through an anteromedial gastrostomy and hemostasis was achieved by transfixing stitches. Ulcers were excised whenever possible, or excluded if adherent posteriorly. Four-quadrant biopsy was taken for frozen section to exclude malignancy. Both anterior and posterior gastric walls were then closed with nonabsorbable suture material. Results: There were 6 men and 2 women with a mean age of 73 years. Hemoglobin levels ranged from 5.2 to 8.0 g/dL. Five patients underwent emergency surgery within 28 hours of admission. The diameter of the ulcers ranged from 2 to 5 cm. Ulcerectomy was performed in 6 cases. In the remaining 2 patients, the crater of the ulcer was adherent to the diaphragm and required exclusion from the gastrointestinal tract. None of the ulcers proved to be malignant, and there were no operative deaths. Patients were followed up for a mean of 3 years with no complications. Conclusions: Satisfactory results can be achieved with a transgastric approach to these rare ulcers. This allows definitive treatment while avoiding major gastric resection with its potential complications.

Original languageEnglish (US)
Pages (from-to)757-762
Number of pages6
JournalArchives of Surgery
Volume138
Issue number7
DOIs
StatePublished - Jul 1 2003

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Ulcer
Stomach
Hemorrhage
Gastrostomy
Frozen Sections
Diaphragm
Hemostasis
Sutures
Endoscopy
Gastrointestinal Tract
Shock
Hemoglobins
Emergencies
Biopsy
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Transgastric surgery for posterior juxtacardial ulcers : A minimal and safe approach. / Camprodon, Ricardo A.M.; Al-Ghnaniem, Reyad; Camprodon, Ricard; Thompson, Jon S.

In: Archives of Surgery, Vol. 138, No. 7, 01.07.2003, p. 757-762.

Research output: Contribution to journalArticle

Camprodon, Ricardo A.M. ; Al-Ghnaniem, Reyad ; Camprodon, Ricard ; Thompson, Jon S. / Transgastric surgery for posterior juxtacardial ulcers : A minimal and safe approach. In: Archives of Surgery. 2003 ; Vol. 138, No. 7. pp. 757-762.
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