When is surgical management of peptic ulcer disease (PUD) indicated?

Updated: Apr 26, 2021
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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With the success of medical therapy, surgery has a very limited role in the management of peptic ulcer disease. Elective peptic ulcer surgery has been virtually abandoned. In the 1980s, the number of elective operations for peptic ulcer disease dropped more than 70%, and emergent operations accounted for more than 80%. [66] In general, 5% of bleeding ulcers eventually require operative management. The indications for urgent surgery include the following:

  • Failure to achieve hemostasis endoscopically

  • Recurrent bleeding despite endoscopic attempts at achieving hemostasis (many advocate surgery after two failed endoscopic attempts)

  • Perforation

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