title: The outcome of urgent surgery for major peptic ulcer haemorrhage following failed endoscopic therapy.
abstract: OBJECTIVE
  To review the outcome of patients who underwent emergency surgery for major peptic ulcer haemorrhage after failed endoscopic therapy. To address whether 'conservative' or 'aggressive' surgery is best.
  
  
  METHODS
  A retrospective analysis of emergency surgery for ulcer bleeding which could not be controlled by endoscopic therapy.
  
  
  METHODS
  The four admitting units in the Lothian region of Scotland.
  
  
  METHODS
  Sixty-seven patients who failed endoscopic therapy for bleeding peptic ulcer and underwent emergency surgery between December 1990 and December 1995. Simple underrunning or excision of ulcer alone was done in 31 patients whilst 36 had more radical surgery.
  
  
  METHODS
  Rebleeding and 30-day mortality rates.
  
  
  RESULTS
  Rebleeding was significantly higher in patients treated by underrunning (7 versus 1, P < 0.013). There were fewer deaths in the radically treated group (5 versus 7, not significant).
  
  
  CONCLUSIONS
  Patients undergoing surgical operation for severe peptic ulcer haemorrhage after failed endoscopic therapy may be best served by a relatively aggressive approach.
authors.affiliation: Gastro-intestinal Unit, Western General Hospital, Edinburgh, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Kubba
authors.forename: C
authors.initials: C
authors.lastname: Choudari
authors.forename: C
authors.initials: C
authors.lastname: Rajgopal
authors.forename: K R
authors.initials: KR
authors.lastname: Palmer
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure