Surgical treatment of bleeding and perforated peptic ulcer diseases

From 1977 to 1988, 556 patients underwent emergency surgery for complicated peptic ulcers. Among them, 409 patients were for treated perforations and 147 for hemorrhages. In the perforated ulcer category, the morbidity rate was 12.5% and mortality rate 6.8%. For bleeding ulcers, the morbidity rate was 27.2% and mortality rate 14.9%. Several risk factors, such as age, interval of time between perforation and surgery, blood loss, associated disease, and shock were found to have created a higher operative risk. A definitive surgery including vagotomy and drainage, vagotomy and antrectomy, partial gastrectomy and highly selective vagotomy could be safely performed with an acceptable mortality for properly selected cases. Follow-up results also indicated better scores in this group of patients. We concluded that a definitive ulcer operation is safe, acceptable and curative for low risk patients with perforated or bleeding ulcers.