Emergency operation for upper gastrointestinal hemorrhage

From January 1973 through December 1977, 580 patients presented with 624 episodes of upper gastrointestinal hemorrhage at the University fo Pittsburgh Health Center Hospitals. Ninety-one patients (15%) underwent operation for uncontrollable hemorrhage. Operative mortality was 30 per cent for all patients and 21 per cent for patients with gastroduodenal bleeding (duodenal ulcer, gastric ulcer, erosive gastritis). In patients with gastroduodenal bleeding, seven of 15(47%) with preoperative hypotensive shock (systolic b.p. less than or equal to .02). Twenty-five patients had vagotomy and pyloroplasty with suture ligation of bleeding ulcers, while 34 patients underwent gastric resection. The operative mortality for resection was 21 per cent (7/34) compared with 16 percent (4/25) for vagotomy and pyloroplasty. The incidence of rebleeding was 15 per cent (5/34) for resection and 8 per cent (2/25 for vagotomy and pyloroplasty. Nine patients (26%) has suture-line leaks following resection, and none were found after vagotomy and pyloroplasty. Severe of nine patients (78%) who had leaks after resection had hypotensive shock prior to operation. Six of the seven patients who died following gastric resection had complication (either leak or rebleeding) directly related to the operative procedure, while the four deaths following vagotomy and pyloroplasty occurred in patients not having procedure-related complications. Procedure-related morbidity (leaks and rebleeding) with resection (41%) was significantly higher than with vagotomy and pyloroplasty (8%) (P less than or equal to .01). These data show vagotomy and pyloroplasty to be the safer operation for patients with uncontrollable gastroduodenal hemorrhage, particularly those with preoperative hypotension.