Outcomes of Salvage Emergency Surgery for Bleeding Peptic Ulcer

The goals of management of bleeding peptic ulcer disease (BPUD) are early diagnosis, prompt resuscitation, and urgent endoscopy to stop bleeding. Last few decades have witnessed a diminishing role of surgery in the management of BPUD. When non-operative strategies such as endoscopy and angioembolization fail to achieve hemostasis, surgery is used as the last resort. This is a case series analysis of 70 patients with BPUD who underwent emergency surgery from January 2002 to December 2014. Demographic profile, clinical parameters, and perioperative outcomes were studied. Baseline data of survivors was compared with non-survivors. Outcome of patients with > 2 endoscopic attempts was compared with <= 2 endoscopic attempt patients. Mean age of the patients was 68.5 years (range 38-93) and majority were male (85.7%). Thirty-nine patients (55.7%) had duodenal ulcers (DU). Among patients with gastric ulcers (GU), the most common location was incisura (n = 16, 51.6%). Most patients had two endoscopic procedures before surgery was undertaken. The most frequent operations performed were under running of duodenal ulcer (n = 40, 57.1%). Fifty-nine patients (84.3%) developed complications and 30-day mortality was 15.7%. There was no difference in demographic and clinical profile of survivors compared to non-survivors. Patients who received > 2 endoscopies had lower hemoglobin (p = 0.01) compared to patients with <= 2 endoscopies, but there was no difference in 30-day mortality (p = 0.68). Exhaustive non-operative strategy and reserving surgery as salvage in refractory BPUD gives acceptable outcomes.