[The current aspects of the diagnosis and procedure in gastroduodenal hemorrhages of ulcerous origin].

Basic problem in all discussions on bleeding gastroduodenal ulcers is the one pertaining to the surgical tactics and to the ascertainment of the indications for surgical intervention and the time for its performance. Adequate answer to this question comes from recognition of the following points: 1. Endoscopically established bleeding source and intensity; 2. Considerations on other endoscopic criteria, clinical manifestations of bleeding--hematemesis, melena or both, changes in the controlled hemodynamic and hematologic parameters, as well evaluation of the accompanying diseases of major and secondary importance on the part of the cardiovascular and respiratory system; 3. Site and time of application of electrocoagulation and periulcer sclerosification in patients considered adequate for them, complying with the indications and contraindications; 4. Adequately chosen operative method. For the period 1985-1990 a total of 81 patients with bleeding from gastroduodenal ulcers, uncontrollable by conservative treatment, have been operated; 37 of them died (overall lethality 13.96 per cent, operative lethality 45.67 per cent). The choice of surgery depended on the localization, nature and extent of the pathologic process, the type and anatomical position of the pathologic focus, correlation with tissues adjacent to the pathologic process, presence of adhesions, callosity, etc. The method of choice was gastric resection by Billroth I, which was preferred to Billroth II resection. Other methods being used were: excision and pyloroplasty, excision, pyloroplasty + vagotomy, suture + vagotomy--mainly for ulcers localized on the anterior duodenal wall, suture, suture + vagotomy, ligation of a. gastrica sin., etc.