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Conservative surgery for bleeding peptic ulcer.

1967; BMJ; Volume: 1; Issue: 5532 Linguagem: Inglês

10.1136/bmj.1.5532.80

0959-8138

Robert K. Carruthers, G R Giles, C G Clark, J C Goligher,

Gastrointestinal Bleeding Diagnosis and Treatment

3leeding peptic ulcer accounts for 80 to 85 ! ; ; of hospital admissions for gastrointestinal haemorrhage (Tanner, 1954 Avery Jones, 1957; Aird, 1957).Improved supportive therapy and greater co-operation between physicians and surgeons have lowered the mortality in this condition.Mortality is influenced by the age of the patient, the severity of the bleeding, and the site of the ulcer.Patients over the age of 50 who continue to bleed may die unless treated surgically (Avery Jones, 1947).Chinn, Littell, Badger, and Beams (1956) found that patients 'inder 50 had a mortality of 6% for duodenal ulcer compared with 22% for gastric ulcer, and in those over 50 the mortality ,vas 14% and 48% respectively.On the other hand, Coghill and Willocx (1960) reported a mortality of 23% after emer- zency surgery for duodenal ulcer.Partial gastrectomy has been the operation most frequently mployed, and in selected cases the mortality has been as low is 5% (Ogilvie, Cardoe, and Bentley, 1952).Variations in the reported mortality can be accounted for by differences in the cases studied.The average mortality in patients with moderate ro severe haemorrhage from all types of ulcer treated by partial gastrectomy is probably nearer 15 % (Ward-McQuaid, Pease, Smith, and Twort, 1960).Smith and Farris (1958) suggested that this might be reduced by a more conservative operation in duodenal ulcer consisting in direct suture of the bleeding vessel with vagotomy and a gastric drainage procedure.We have adopted this technique where circumstances seemed appropriate, and our experience of the surgical management of bleeding peptic ulcer is recorded. Methods and ResultsDuring 1960-5 117 patients with haemorrhage from peptic ulcer were treated by emergency operation.They were referred from several physicians and the criteria for surgical referral varied widely.The majority of them, however, were operated on without delay, although during this period three others died after consultation but before surgery could be performed.Five patients had haemorrhage from stomal ulceration-three after partial gastrectomy and two after gastroenterostomy; all were treated by vagotomy and gastric resection and there were no deaths.They have been excluded from further considera- tion.Of the remaining 112 patients 62 were treated in Aberdeen Royal Infirmary and 50 in the Professorial Surgical Unit in Leeds.There were 78 males and 34 females, whose ages ranged from 20 to 88 years.Haemorrhage resulted from acute erosions in 13 patients, from duodenal ulcer in 79, and from gastric ulcer in 20.In six of the latter there was an associated duodenal ulcer.