[Change in the risk of gastroduodenal ulcer hemorrhage--preventive or elective operation?]

Prophylactic (early elective) surgery of bleeding gastroduodenal ulcers is performed to avoid rebleeding with a supposed high risk. Because early elective surgery was burdened with high risk for complications and because surgery for rebleeding ulcers had no higher risk, we left these procedures and performed repeated endoscopic treatment of these patients instead. A retrospective analysis should clarify, whether the modified treatment since 1/90 changed the risk of bleeding gastroduodenal ulcers. Patients of other hospitals, who were assigned after unsuccessful attempts of conservative treatment were analysed separately from patients of the emergency ward of our department. In the second period patients from other hospitals were in worse condition, they had more concomitant diseases and more intense bleedings than in the first period. In our opinion this could be attributed to carrying too far conservative treatment. The frequency of operations decreased only little in this group, whereas the complication rate and the mortality increased slightly. With the abandonment of early elective surgery in patients of our emergency ward, we reached a decrease of the operative-frequency of more than 30%, a decrease of complications from 27.6% to 10.0% and of mortality from 10.3% to 0%. Over-all mortality was reduced from 9.8% to 4.7%.