Treatment of duodenal ulcer in a small metropolitan community hospital

Abstract

VAILABLE TODAY for the surgical treatment A of the complications of duodenal ulcer is a spectrum of basic procedures ranging from gastrojejunostomy or modified gastrojejunostomy as recently revived by Poth and Gold [1] to classical gastric resection. It appears increasingly evident that the addition of vagus neurectomy to these standard procedures for duodenal ulcer has lowered the recurrence rate appreciably, and the feasibility and success of pyloroplasty and vagus resection have been established in many centers. Recurrence rates after gastric resection and vagus neurectomy are satisfactory; however, in many series the mortality associated with gastric resection, due principally to difficulties with the duodenal stump, is higher than one should tolerate in the surgical treatment of a benign disease. The present study details the results of the surgical treatment of duodenal ulcer in a small metropolitan community hospital. The surgical staff participating in this study consists of trained surgeons, all either Fellows of the American College of Surgeons, Diplomates of the American Board of Surgery, or qualified by training for the examination of the American Board of Surgery. A retrospective study of the hospital course, mortality, and morbidity of operations for duodenal ulcer is herein presented. From January 1958 to February 1963 gastric resection was employed for the complications of duodenal ulcer in all patients. Since February 1, 1963, all patients with duodenal ulcer treated surgically have been subjected to vagus resection, pyloroplasty with or without plication of the ulcer, and gastrostomy. Fifty-five patients were treated between January 1958 and February 1963 and fifty-two patients from February 1963 to the time of this writing. A comparison will be made of the immediate results of these two operative procedures and the indication for surgical treatment will be listed. In all patients, except some with perforation or massive bleeding, the diagnosis of duodenal ulcer had been confirmed on several occasions by gastrointestinal roentgenographic studies. Gastric acid studies by the twelve hour basal night secretion technic were employed in many patients, and in the remainder a typical histamine gastric analysis was carried out. The two groups were almost identical in composition as related to age, sex, and economic status.