MODERN APPROACHES TO THE SELECTION AND OPTIMIZATION OF SURGICAL MANAGEMENT FOR DUODENAL ULCER BLEEDING CONSIDERING THE SEVERITY OF BLOOD LOSS AND THE RISK OF RECURRENT BLEEDING

Bleeding from duodenal ulcers remains one of the most pressing problems in emergency abdominal surgery due to the high risk of severe blood loss, hemorrhagic shock, recurrent bleeding, and adverse treatment outcomes. Despite improvements in endoscopic hemostatic techniques, the introduction of modern antisecretory medications, and advances in interventional radiology, the timely identification of indications for surgical intervention and the selection of the most effective treatment strategy remain critically important in clinical practice. The present study aims to investigate current approaches to the selection and optimization of surgical treat­ment strategies for patients with bleeding duodenal ulcers, taking into account the severity of blood loss, endoscopic characteristics of the ulcer, the patient's hemodynamic status, and the probability of recurrent bleeding. The study analyzes the diagnostic and therapeutic capabilities of emergency esophagogastroduodenoscopy, endoscopic hemostatic techniques, pharmacological therapy, transcatheter angiographic embolization, and conven­tional surgical interventions. Particular attention is paid to assessing the severity of bleeding, determining its activity according to the Forrest classification, applying the Glasgow-Blatchford and Rockall prognostic scoring systems, and identifying factors associated with an increased risk of recurrent bleeding. The main principles of treatment selection are examined according to the severity of blood loss, ulcer size and location, hemostatic status, the presence of comorbidities, and the effectiveness of initial therapeutic measures. The importance of a differentiated treatment approach is emphasized, with endoscopic hemostasis considered the first-line intervention for active ulcer bleeding when clinically indicated. In cases of recurrent bleeding, the possibilities of repeat endoscopic intervention and transcatheter angio­graphic embolization are considered. Surgical treatment remains essential when less invasive methods fail, in cases of persistent massive bleeding, and in patients with hemodynamic instability requiring definitive hemorrhage control. The choice of surgical intervention should be based on an individualized assessment of operative risks and the ana­tomical characteristics of the ulcer defect, consistent with modern multidisciplinary principles for managing gastro­duodenal ulcer bleeding. Considerable attention is devoted to the prevention of recurrent bleeding, timely correction of hemodynamic disturbances, appropriate use of proton pump inhibitors, diagnosis and eradication of Helicobacter pylori infection, and dynamic monitoring of patients during the early postoperative period.