SURGICAL APPROACH TO DIGESTIVE BLEEDING REFRACTORY TO CLINICAL TREATMENT

Abstract

Refractory gastrointestinal bleeding (RGB) represents a clinical challenge with high mortality, defined by the persistence or recurrence of massive bleeding despite maximal endoscopic and therapeutic attempts. Although endoscopy and angiographic embolization are the first-line approaches, a significant number of patients require emergency surgical intervention. This systematic review aims to analyze the efficacy and outcomes associated with various surgical treatment techniques employed in RGB cases, focusing on decision-making and the selection of the most appropriate procedure. A systematic search was conducted in the Scielo, PubMed, and Latindex databases, resulting in the selection of 28 articles published in the last five years. The findings indicate that surgery, despite being the last line of treatment, offers high rates of definitive bleeding control, with segmental bowel resections and selective vascular ligations being the most effective techniques, and exploratory laparotomy remaining a crucial step in initial stabilization. Understanding the predictive factors for non-surgical treatment failure is vital to optimize the timing of surgical intervention and improve patient survival.