THE OUTCOME OF URGENT SURGERY FOR MAJOR PEPTIC-ULCER HEMORRHAGE FOLLOWING FAILED ENDOSCOPIC THERAPY

Objective: To review the outcome of patients who underwent emergency s urgery for major peptic ulcer haemorrhage after failed endoscopic ther apy. To address whether 'conservative' or 'aggressive' surgery is best . Design: A retrospective analysis of emergency surgery for ulcer blee ding 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 pepti c ulcer and underwent emergency surgery between December 1990 and Dece mber 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. Conclusion: Patients undergoin g surgical operation for severe peptic ulcer haemorrhage after failed endoscopic therapy may be best served by a relatively aggressive appro ach.