Surgical management of peptic ulcer

Abstract

1. 1. 54.0 per cent of 211 patients with peptic ulcer had either acute or chronic gastrointestinal hemorrhage preoperatively. 49.0 per cent of the patients with preoperative bleeding had massive bleeding and required five or more units of whole blood. 2. 2. 94.7 per cent of 211 consecutive patients with peptic ulcer underwent vagotomy with a drainage procedure as definitive therapy. 3. 3. Six patients (2.7 per cent) died postoperatively, although in only two (0.9 per cent) patients could death be classified due to operative failure since fatal hemorrhage recurred. 4. 4. The current status is known in 96.6 per cent (198) of 205 patients. 49.7 per cent of 205 postoperative patients have been followed up from five to nineteen years. The longest follow-up period is in excess of nineteen years and concerns a patient who underwent vagotomy and gastroenterostomy for severe bleeding in 1949. 5. 5. The proved peptic ulcer recurrence rate is 1.9 per cent (four patients) of 205 patients. The possible recurrence is 2.9 per cent (six patients) and the combined total is 4.8 per cent. There was no recurrence of gastric ulcer in twenty-seven patients or in ten additional patients with simultaneous gastric and duodenal ulcer. These data strongly support vagotomy with a drainage procedure for the following conditions: (1) acute and chronic duodenal ulcer, including massive hemorrhage; (2) benign gastric ulcer; (3) simultaneous duodenal and gastric ulcer.