Gastrointestinal Bleeding Surgery: Effective Treatment Options for Upper GI Hemorrhage

When medical management fails to control severe upper gastrointestinal (GI) bleeding, surgical intervention becomes a critical treatment option. The choice of surgical procedure depends on the underlying cause of hemorrhage, patient stability, and response to initial therapies.

Common Causes Requiring Surgical Intervention

Upper GI bleeding can originate from various pathological conditions including:

• Esophageal and gastric varices caused by portal hypertension in cirrhosis patients
• Peptic ulcer disease with active bleeding
• Gastric malignancies presenting with hemorrhage
• Biliary tract bleeding (hemobilia)

Specific Surgical Approaches

Peptic Ulcer Bleeding

In cases of severe peptic ulcer hemorrhage unresponsive to endoscopic treatment, partial gastrectomy remains a definitive solution. This procedure involves removing the ulcerated portion of the stomach containing the bleeding lesion, followed by gastrointestinal reconstruction to maintain digestive continuity.

Variceal Bleeding in Cirrhosis

For patients with portal hypertension-induced variceal bleeding, surgical options focus on reducing venous pressure. The Sugiura procedure or periesophageal devascularization effectively controls bleeding by interrupting the collateral circulation around the gastroesophageal junction while preserving vital structures.

Gastric Cancer-Related Hemorrhage

Malignant bleeding requires oncologic resection of the affected gastric tissue combined with lymph node dissection. The surgical approach must balance hemorrhage control with cancer staging and potential for curative treatment.

Modern Surgical Considerations

While endoscopic therapies have reduced the need for emergency surgery, timely operative intervention remains crucial for hemodynamically unstable patients or those failing endoscopic management. Surgeons now combine traditional open approaches with minimally invasive techniques to optimize patient outcomes.

Postoperative management emphasizes close monitoring in specialized units, appropriate antibiotic prophylaxis, and multidisciplinary follow-up to prevent rebleeding and manage underlying conditions like liver disease or malignancy.