Geographical aspects of peptic ulcer surgery

Abstract

The geographic distribution of duodenal ulcer and its characteristics in rural areas of high incidence in developing countries are reviewed. The choice of surgical procedures is discussed in light of the bulky diet and nutritional problems of these countries. A vagotomy procedure is advised for duodenal ulcer and a Billroth I gastrectomy for gastric ulcers of the body of the stomach.

Helicobacter pylori in Africa: Observations on an ‘enigma within an enigma’

“…In addition, a review of the literature reveals that the several assumptions regarding peptic ulcer incidence in sub‐Saharan Africa have been based on clinical findings, X‐ray evidence, surgical experience and necroscopy examinations reported 20–30 years ago. 4,5 In spite of these difficulties, a review of the prospective, endoscopically based studies in the H. pylori era, albeit in subjects who have been selected by varying criteria which may represent a selection bias, is somewhat at odds with current perceptions. Indeed, it would appear that the organism’s association with gastritis in Africa is as strong as in the rest of the world and the available data generated in the endoscopy era suggest that the infection is strongly associated with PUD, while PUD itself may not be as rare as is commonly perceived.…”

“… 3 The ‘evidence’ for these views is derived largely from sero‐epidemiological studies in asymptomatic individuals combined with anecdotal evidence about the prevalence of various disease entities. 1–5 The perceived lack of a pathogenic effect is rationalized by generalizations that major differences may exist in H. pylori‐ associated disease expression between developed and developing countries. Factors such as an earlier age of exposure, higher frequency of re‐exposure, H. pylori strain variations, poorly defined environmental factors (e.g.…”

Recurrence rate after highly selective vagotomy

“…In order to improve the results, attempts were ruade to delineate the surgeon failures and, according to many reports, subsequent improvement of technique diminished the number of failures [8][9][10][11][12][13][14][15][16][17][18][19][20]. The supposed completeness of the vagotomy, however, was not always a guarantee against recurrence [21][22][23][24][25][26], so that it should perhaps be postulated that failures inherent in the method do occur after HSV [27][28][29][30]. Probably all series of HSV's with apparently unavoidable recurrences contain a mixture of method failures and surgeon failures, and these cannot be distinguished with certainty at present.…”