Surgical Management of Acute Upper Gastrointestinal Bleeding

Abstract

• We reviewed the results of operative management of 113 cases of acute upper gastrointestinal (GI) bleeding. The study shows a significant improvement in mortality of emergency and urgent surgery for acute massive upper GI hemorrhage, compared to our earlier report in 1974. The aggressive diagnostic approach utilized endoscopy or abdominal angiogram as an initial diagnostic procedure, which provided accurate or useful information regarding the source and nature of the bleeding in 98% of the cases, and the prompt surgical intervention when (1) a patient continued to bleed, requiring blood transfusions at the rate of more than 500 ml in six hours in order to maintain stable vital signs; (2) recurrent bleeding developed while the patient was under treatment in the hospital; and (3) the patient had an actively bleeding gastric ulcer. This aggressive diagnostic approach was the principal contributing factor in improved survival rate. The choice of operative procedure in acutely bleeding patients should be made on the basis of local findings, the nature of bleeding lesions, the general condition and age of the patient, and the experience of the operating surgeon. Our study does not permit a valid conclusion as to the operative procedure of choice for massive upper GI bleeding. Vagotomy and pyloroplasty with suture ligation of bleeding points was more frequently used in critically ill, poor-risk patients, where more extensive resectional surgery was not warranted, and has been found to be extremely effective in controlling the bleeding. (Arch Surg113:1444-1447, 1978)