The outcome of urgent surgery for major peptic ulcer haemorrhage following failed endoscopic therapy

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Objective:To review the outcome of patients who underwent emergency surgery for major peptic ulcer haemorrhage after failed endoscopic therapy. To address whether 'conservative' or 'aggressive' surgery is best.Design:A retrospective analysis of emergency surgery for ulcer bleeding which could not be controlled by endoscopic therapy.Setting:The four admitting units in the Lothian region of Scotland.Participants:Sixty-seven patients who failed endoscopic therapy for bleeding peptic ulcer and underwent emergency surgery between December 1990 and December 1995. Simple underrunning or excision of ulcer alone was done in 31 patients whilst 36 had more radical surgery.Main outcome measures:Rebleeding and 30-day mortality rates.Results:Rebleeding was significantly higher in patients treated by underrunning (7 versus 1, P<0.013). There were fewer deaths in the radically treated group (5 versus 7, not significant).Conclusion:Patients undergoing surgical operation for severe peptic ulcer haemorrhage after failed endoscopic therapy may be best served by a relatively aggressive approach.European Journal of Gastroenterology & Hepatology 1996, 8:1175–1178

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