SURGERY FOR MASSIVE PEPTIC-ULCER HEMORRHA GE - PREDICTIVE FACTORS OF OPERATIVE MORTALITY

Objectives. - Multivariate analysis of operative mortality in patients with bleeding peptic ulcer. Methods. - Seventy-eight consecutive pati ents, who underwent emergency surgical treatment for bleeding peptic u lcer were reviewed retrospectively. There were 49 males and 29 females , with a mean age of 64.3 years, 2/3 of whom had associated medical di sease. Surgical treatment was conservative in 63 cases: oversewing or ulcer excision, alone (n = 29) or associated with vagotomy (n = 34/; a nd was radical in 15 cases: antrectomy + vagotomy (n = 10) or partial gastric resection (n = 5). Results. - There twelve 17 (21.8 %) postope rative deaths and 19 (24.3 %) bleeding recurrences. The causes of deat h included 9 bleeding recurrences, 7 organ failures and one duodenal l eakage. On multivariate analysis, previous medical illness (cirrhosis or cardiac insufficiency (P < 0.001), shock at admission (P < 0.001), prolonged delay until surgery (P < 0.001), and bleeding recurrence (P < 0.001) were independently associated with increased mortality. In co ntrast, the type of surgical procedure did not influence postoperative mortality, whereas bleeding recurrence was more frequent in case of c onservative surgery (P < 0.03) and anticoagulation therapy (P < 0.01). Conclusion. - These results suggest that surgical treatment of bleedi ng peptic ulcer should be proposed early in high-risk patients. A radi cal procedure should be favoured since it reduces bleeding recurrence rate without increasing operative mortality.