Surgery: When to Operate and When to Resuscitate and What Kind of Operation?

Despite significant advances in endoscopic and interventional radiologic therapeutic technologies and resuscitation techniques, non-variceal upper gastrointestinal hemorrhage remains a challenge for providers, and the mortality from it remains substantial. Because of the advent of proton-pump inhibitors, the treatment of Helicobacter pylori, and the aforementioned advancement of endoscopic and interventional angiographic techniques, surgery for peptic ulcers is a relative rarity. Furthermore, the generation of surgeons that had mastery of the surgical techniques used to manage difficult peptic ulcer-related surgical complications is retiring or nearing retirement. Multidisciplinary approaches to upper gastrointestinal hemorrhage are therefore common and beneficial to patients but can provide a challenge in terms of leadership, coordination, and decision-making. It is incumbent on providers caring for these patients to have a broad understanding of the diagnostic and therapeutic techniques available to them to provide rapid and coordinated care.