Operative treatment of benign gastric ulcers

Abstract

Between the years 1953 and 1963, 1,583 patients at the Henry Ford Hospital were recorded as having gastric ulcer. Of this number 150 (9.4 per cent) underwent operative treatment. Failure to respond favorably after medical treatment and suspicion of malignancy prompted surgical intervention most often. Two operative approaches were commonly employed. Gastric resection plus vagotomy with Billroth I reconstruction was utilized in fifty-three patients. Gastric resection with vagotomy and Billroth II reconstruction was the procedure of choice in twenty-nine patients. Thus, eighty-two patients had gastric resection with vagotomy. There were four recurrences in this group (5 per cent). The second largest group of patients were those upon whom gastric resection was performed without vagotomy. The Billroth I reconstruction was performed thirty-one times and the Billroth II procedure was employed twenty-one times. There were nine recurrences in fifty-two patients, a recurrence rate of nearly 17 per cent. Clearly, in this study, gastric resection with vagotomy gave better results (5 per cent recurrence) than did gastric resection alone (17 per cent recurrence). The over-all recurrence rata for 150 patients was approximately 11 per cent. In eight patients the clinical diagnosis was benign ulcer when, in fact, malignancy was present. In two patients, the tumor was lymphoma. Only one of ten patients died of tumor. Excellent follow-up studies were possible in every patient with a malignant lesion. Adequate gastric resection is effective for these small, unsuspected ulcerocarcinomas. There were four postoperative deaths, a mortality rate of 2.7 per cent. Two patients died of myocardial infarction and two died of pulmonary emboli.