Acute surgical treatment of bleeding peptic ulcer. A retrospective analysis of 193 patients.

A retrospective analysis of 193 consecutive patients over an 11 year period operated on for continued bleeding from gastric or duodenal ulcer is presented. All patients were operated on within the first 48 hours after hospitalization. Preoperative endoscopic examination was performed in 108 patients and it was diagnostic in 79% of the cases. A sole duodenal ulcer was responsible for bleeding in 59 patients (31%) and in 50 patients (26%) the bleeding ulcer was located in the lesser curvature of the stomach. Other gastric ulcerations were scattered irregularly in different parts of the stomach. Gastric resection and Billroth II reconstruction were the most common procedures performed. Vagotomy, either truncal or gastric, was added to the resection in 31 (16%) cases. Primary mortality rate within 45 days from the operation was 15%. The survivors were on the average ten years younger (mean 58 years) than those who died. Forty one (21%) of the patients were operated on as emergency cases. These patients survived significantly better than those operated on after an observation period. It is concluded, that aggressive surgical treatment immediately after fluid resuscitation was associated with a reduction in mortality and morbidity rates in patients with bleeding peptic ulcer.