Bleeding peptic ulcer: results of surgical management.

Aim of the study: The aim of this retrospective study was to report the mor tality and morbidity after surgery for bleeding peptic ulcer while the popu lation is aging and while the medical treatment and endoscopic procedures a re improving. Patients and methods: This retrospective study between 1994 and 1999 includ ed 49 patients, 15 women, 34 men, aged 72 +/- 14 years. Patients were separ ated into three groups: ten with uncontrollable haemorrhages, 28 with recur rent haemorrhages and 11 with persistent haemorrhages. These patients were classified ASA II (n = 6), ASA III (n= 20), ASA IV (n = 21) and ASA V (n = 2). The surgical procedures for gastric ulcers (n = 5) were resection-overs ewing (n = 2) or partial gastric resection (n = 3). The surgical procedures for duodenal ulcers (n = 44) were oversewing (n = 30), partial gastric res ection (n = 10) or exploratory duodenotomy (n = 4). Results: The overall postoperative mortality rate was 20.4% (10/49). The mo rtality rate was 40% (4/10) in patients with massive haemorrhage, 7% (2/28) in patients with recurrent haemorrhage, and 36% (4/11) in patients with pe rsistent haemorrhage. There was no significant difference in the mortality rate in relation to the surgical procedures. The morbidity rate was 45%, in cluding three bleeding recurrences after suture and three duodenal leakages after partial gastric resection. Conclusion: The morbidity and mortality rate after surgery for bleeding pep tic ulcer is still high. Recurrent haemorrhages don't worsen the prognosis. Delayed surgery for persistent haemorrhage is associated with a severe pro gnosis. (C) 2001 Editions scientifiques et medicales Elsevier SAS.