[Surgery of hemorrhaging peptic ulcer]

Surgical therapy in upper gastrointestinal bleeding is preferred, if bleeding does not stop spontaneously or an increased risk of recurrent bleeding exists. Absolute indications for surgical intervention is given after blood replacement of 1500 ml/24 hs or 1000 ml in 4 hs, a recurrent bleeding after an initial stop, a continuous bleeding for 24 hours especially in patients over 50 years, the coincidence of bleeding and perforation, and an endoscopically proven visible vessel in the ulceration. A relative indication for surgical intervention is given in patients over 50 years of age, severe second illness in chronic ulceration, pain during active bleeding and problems in blood replacement. Principles of surgical therapy consist of local ligation, devascularisation of the bleeding area of the stomach, gastric resection or vagotomy in different forms. In most cases several therapeutical principles are used. Mortality of operations in active upper gastrointestinal bleeding is around 14%. Recurrent bleeding after operation will happen in about 9%. Bleeding stress ulcerations have a bad prognosis. At the Department of Surgery, University of Göttingen, 178 patients have been operated during the last years because of actively bleeding gastrointestinal ulceration. Total mortality was 12.9% (gastric ulceration 18.6%, duodenal ulceration 9.3%). The surgical therapy of choice has been ligation of bleeding vessel in gastric ulceration and local ligature of the afferent vessel together with stitching of the bleeding vessel under preservation of the pylorus in duodenal ulcer patients. In stress ulceration operation has to be avoided otherwise a vagotomy and resection is performed.