EMERGENCY SURGICAL-TREATMENT FOR BLEEDING DUODENAL-ULCER - OVERSEWINGPLUS VAGOTOMY VERSUS GASTRIC RESECTION, A CONTROLLED RANDOMIZED TRIAL

The best surgical procedure to treat bleeding bulbar peptic ulcer is u nknown. The rates of postoperative bleeding recurrence, duodenal leaka ge, and mortality were compared in patients undergoing oversewing plus vagotomy (O+V) or gastric resection (GR) with ulcer excision. Of 202 patients undergoing emergency surgery for massive, persistent, or recu rrent bleeding from bulbar peptic ulcer, 120 patients were enrolled in a prospective randomized trial. Fifty-nine were assigned to O+V and 6 1 to GR. One patient in each group was excluded after randomization. T he two groups were well matched with respect to clinical and prognosti c factors. The rate of postoperative bleeding recurrence was 17% after O+V and 3% after GR (p < 0.05). The duodenal leak rate was higher aft er GR than after O+V (13% vs. 3%) (p < 0.10) but was not different whe n the morbidity of reoperations for bleeding recurrence after O+V was considered on an ''intention to treat'' basis (12% vs. 13%). Overall p ostoperative mortality was similar: 22% (O+V) versus 23% (GR). Sixteen deaths were unrelated to the surgical procedure itself. Of 82 nonrand omized patients, 10 were not analyzed. In the 72 other nonrandomized p atients, bleeding recurrence, duodenal leakage, and postoperative mort ality rates were consistent with the results of the controlled trial, as they were 29% (O+V 32%; GR 0.7%), 16% (O+V 0.7%; GR 26%) and 27% (O +V 18%; GR 33.3%), respectively. We conclude that GR with ulcer excisi on is the procedure of choice for the emergency surgical treatment of bleeding duodenal ulcer because postoperative bleeding recurrence is l ower, and the overall rates of mortality and duodenal leakage are the same as with O+V.