ABSTRACT
The surgical approach to gastroduodenal pathology includes consideration of the most frequently encountered diagnoses: bleeding, perforation, and obstruction. While other phenomena may present urgently, for example, bezoars, foreign bodies, parasitic disease, and others, they are far less commonly encountered by surgeons. The goals of therapy for any gastroduodenal procedure include cessation of bleeding, control of contamination, restoration of continuity, and the treatment of underlying etiology. Surgical complications of gastroduodenal pathology may be approached with similar respect for the functional anatomy and physiology, but will include particularities specific to the diagnosis. The high-income countries (HICs) of the world will include advanced imaging, endoscopic techniques, and nonsurgical therapies, and these are important to consider. As low-and middle-income countries (LMICs) differ in the ability to manage acute problems, however, those with differing resources at their disposal may be less facile with one component of the required care. More specifically, experience with the surgical management of gastroduodenal disease is variable. While endoscopy, imaging, and other technologies are available only sparingly, well established-albeit more invasive-management techniques are often required. Changes in the epidemiology of peptic ulcer disease have modified the approach to gastroduodenal surgery, but these changes may be less important in LMICs. The existence of gastroduodenal problems and, more specifically, peptic ulcer disease in the absence of appropriate nonsurgical and antimicrobial therapy in these areas will make useful this review of surgical management.
