Surgery and gastrointestinal bleeding

Therapeutic endoscopy has become the first line treatment for acute ulcer bleeding. Because of this, and the discovery that most ulcers are caused by Helicobacter pylori, the indications for operating intervention and the choice of operation for acute ulcer bleeding need not be reconsidered. surgery is indicated for patients if bleeding is not controlled by endoscopic means, or if rebleeding occurs after endoscopic haemostasis. The most expedient operation that can secure permanent control of bleeding should be chosen. For small ulcers, undersewing or excision of the ulcer is adequate. For larger ulcers a technically difficult gastrectomy is often required to secure haemostasis.