Original Paper

Surgical Salvage of Bleeding Peptic Ulcers after Failed Therapeutic Endoscopy
Philip Wai Yan Chiu^a, Enders Kwok Wai Ng^a, Simon Kin Hung Wong^a, Anthony Yuen Bun Teoh^a, Frances Ka Yin Cheung^a, Man-yee Yung^a, Joseph Jao Yiu Sung^b, James Yun Wong Lau^a

Departments of
^aSurgery and
^bMedicine and Therapeutics, Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China

Address of Corresponding Author

Dig Surg 2009;26:243-248 (DOI: 10.1159/000226218)

  Key Words

• Bleeding peptic ulcers
• Salvage surgery
• Failed endoscopic therapy

  Abstract

Background: The approach to salvage surgery after failed endoscopic therapy for a bleeding peptic ulcer is controversial. We aimed to compare the outcomes of salvage surgery after failed endoscopic therapy for bleeding peptic ulcers over a 10-year period. Methods: Patients receiving salvage surgery for bleeding peptic ulcers were divided into 2 cohorts, the 1st from 1993 to 1998 and the 2nd from 1999 to 2004. The type of salvage surgery was defined as minimal if ulcer plication or an ulcerectomy was performed, and definitive if the patient received a vagotomy or gastrectomy. Results: One hundred and twenty-three patients received salvage surgery in the 1st cohort, while 42 patients received surgical hemostasis for the bleeding peptic ulcer in the 2nd cohort. Patients in the 2nd cohort consisted of a larger proportion of in-hospital bleeders (cohort 1: 12.2%, cohort 2: 42.9%; p < 0.005) and had a significantly higher proportion of comorbidities. A larger number of patients received minimal surgery in cohort 2 (cohort 1: 42.3%, cohort 2: 73.8%; p < 0.005). Conclusions: With advances in therapeutic endoscopy, patients who developed failed endoscopic hemostasis are likely to be poor surgical candidates with multiple comorbidities. The approach to salvage surgery has inclined towards minimal surgery to hasten surgical hemostasis among these fragile patients.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Dr. Philip W.Y. Chiu, Department of Surgery, Prince of Wales Hospital
The Chinese University of Hong Kong
30–32 Ngan Shing Street, Shatin, N.T., Hong Kong, SAR (China)
Tel. +86 852 2632 2627, Fax +86 852 2637 7974
E-Mail philipchiu@surgery.cuhk.edu.hk

  Article Information

Received: October 17, 2008
Accepted: March 28, 2009
Published online: June 26, 2009
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 2, Number of References : 25