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Early definitive operation for bleeding peptic ulcer

X Mueller1, J M Rothenbuehler, A Amery

  • 1Allgemeinchirurgische Klinik, Departement Chirurgie, Kantonsspital Basel, Switzerland.

Journal of the Royal College of Surgeons of Edinburgh
|August 1, 1994
PubMed
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Early surgery for bleeding peptic ulcers, including proximal gastric vagotomy (PGV), leads to low hospital mortality and good long-term results. This approach ensures patient stability before definitive operative intervention.

Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Clinical Surgery

Background:

  • Peptic ulcer disease (PUD) with bleeding is a significant cause of morbidity and mortality.
  • Timely surgical intervention is crucial for managing acute gastrointestinal bleeding from peptic ulcers.
  • Optimizing surgical timing and technique can improve patient outcomes.

Purpose of the Study:

  • To evaluate the outcomes of early surgical intervention for bleeding peptic ulcers.
  • To assess the effectiveness and safety of proximal gastric vagotomy (PGV) in treating duodenal ulcers.
  • To determine the impact of early surgical decision-making on hospital mortality and re-bleeding rates.

Main Methods:

  • Retrospective review of 31 patients undergoing surgery for bleeding peptic ulcers.

Related Experiment Videos

  • Focus on early operative decision-making upon patient hemodynamic stability.
  • Performance of definitive operations including hemostasis, with PGV used for duodenal ulcers.
  • Analysis of hospital mortality, postoperative re-bleeding, and long-term follow-up data.

    • Main Results:

    • 77% of patients were operated on within 24 hours.
    • Hospital mortality was 6% (2 deaths).
    • 13% of patients experienced postoperative re-bleeding, requiring re-operation.
    • During a mean 45-month follow-up, one patient had recurrent bleeding; 12 deaths occurred unrelated to PUD.
    • Proximal gastric vagotomy (PGV) in 10 duodenal ulcers had no hospital mortality, with one re-bleed post-operation and one during follow-up.

    Conclusions:

    • Early surgical intervention for bleeding peptic ulcers is associated with low hospital mortality.
    • Proximal gastric vagotomy (PGV) demonstrates good results in treating duodenal ulcers, even when performed by multiple surgeons.
    • A strategy of early surgical intervention upon patient stabilization is supported by these findings.