Introduction: Mortality rate rf bleeding intothe upper GIT has remained relatively unchanged during the past 30 years, i.e. abeut 30%, even thcugh the develepment rfnew techndegies brcught aleng substantial changes in diagnestic and therapeutic procedures. Methodology: This werk deals with the surgical sduticn rf bleeding intothe upper GIT rf peptic etidegy. It covers a 5-year period (frem January 1, 1999 until Octcber 1, 2003) during which time the Regicnal Hcspital in Pardubice admitted 1,310 patients with bleeding intothe upper GIT rf peptic etidegy. 190 rf them were hespitalized at the Surgical Clinic due tothe develeping hemerrhagie shock; the ethers were hcspitalized at the Clinic rflnternal Medicine. If it failed urgent endesecpy tostep the bleeding, the patient was referred toundergo an urgent surgery. If the bleeding was stepped by endesecpy yet it recurred after certain time, a secend endcsccpic hemeestasis was attempted. If it failed, an urgent surgery was indicated. Results: A tetal number cf 24 patients underwent an acute surgery. A frequently ušed proceduře was stemach resecticn, type BII, which was applied toa tetal number rf 12 patients. Hcwever, this type tf urgent surgery was aceempanied with a relatively high number tf ccmplicaticns. Recperaticn had tobě perfermed 4 times (33.3%). In cne čase (8.3%) for recurrent bleeding. In 12 patients cne tf the tfher procedures was perfermed: an injecticn and a trunkal vagtfcmy (3x), an injecticn and the ligaticn tf the gastroduodenal artery (2x), prorimal jejunum resectiai (lx), an injectiai accanpanied with fundcplicatiai acccrding toNissen-Rcsseti (lx). Tworfthe patients whoreceived this ether greup rfprccedures had tobě recperated fer recurrent bleeding (16.7%). Discussion: The decisicn abait a suitable surgical proceduře applicable tobleeding intothe upper GIT after the failure tf endcsccpic haneestasis peses a substantial prcblem. It is necessary to chase from mere radical prccedures — resectiai — that stop bleeding reliably, yet their executiai in an acute cenditien (cften cánciding with the patienťs hemerrhagie shock) results in a relatively large number rfccmplicaticns; and fran less radical procedures that feature a smaller number tf pcst-surgical ccmplicaticns yet that can be burdened with a larger percentile number rf recurrent bleeding. Nearly the samé number rf sericus recurrent bleeding in this study indicates that the apprepriate cháce rfa proceduře (aceerding tothe patienťs current cenditien, uleer localiza-ticn, and associated diseases) makes beth apprcaches (resecticn vs. a less radical proceduře) similar as tothe number rf necessary recperatiens after bleeding. Conclusion: The develepment rf endceccpic metheds introduced significant changes in the diagnestic-thera-peutic algerithm rf bleeding intothe upper GIT. Nevertheless, the chcice rf an apprepriate surgical proceduře centinues topresent a relevant surgical issue.

        Key words: melena - therapeutic endesecpy - peptic uleer - stemach resecticn - vagetemy