RISK-FACTORS IN SURGERY OF GASTRODUODENAL ULCER DISEASE IN PATIENTS WITH SCHISTOSOMAL PORTAL-HYPERTENSION

The present study was conducted to determine the risk factors associat ed with surgical treatment of peptic nicer disease (PUD) in patients w ith schistosomal hepatic fibrosis (SHF). The medical records of 32 pat ients treated at the Department of Surgery, Alexandria Faculty of Medi cine between 1984 and 1994 were reviewed and data were analyzed. Twent y-five patients were male and seven were female, with a mean age of 43 .3 +/- 24. Fifteen patients belonged to Child A and 13 to Child B. Twe nty-one patients were variceal non-bleeders and 11 were bleeders. The ulcer was pyloric or duodenal in 30 patients and gastric in only two. Twenty-four patients were operated upon electively mostly for pyloric obstruction (n=15) and eight patients emergently; five for perforation and three for bleeding. Hepatic insufficiency renal function impairme nt and gastrointestinal bleeding were the most detrimental postoperati ve complications that occurred, either alone of in combination, in 13 patients (40.6%). Eight patients died (25%) of liver failure (n=5), ga strointestinal bleeding (n=2) and multiple systems organ failure (n=1) . Urgency of the operation and Child B were of significance for predic ting mortality in contrast to age, sex, liver size, bleeding varices a nd ulcer location. Based on these data, it may be concluded that 1) op erations for PUD in patients with schistosomal portal hypertension are expected to have high postoperative morbidity and mortality; 2) morta lity rate significantly increases by emergency operations, presence of postoperative complications and in modified Child 13 patients; 3) Liv er function must he optimized preoperatively; and 4) the most simple a nd expeditious procedure must be performed to minimize postoperative c omplications and hepatic decompensation.