Management of recurrent peptic ulceration

Abstract

SUMMARYA series of 117 consecutive patients having operations for recurrent peptic ulcer is reported. There were no initial deaths but 9 patients developed further recurrent ulcer and 2 of 8 who had a third operation died, giving an overall patient mortality of 1.7 per cent. A further 6 patients underwent a third operation to correct bile vomiting or dumping, with no deaths.The mean time of onset of symptoms of recurrent ulcer was 1.9 years after proximal gastric vagotomy, 3.2 years after vagotomy and drainage, 3.3 years after gastrectomy and 1 2 6 years after gastrojejunostomy.One hundred and four patients were followed for more than I year (mean 5.2 years) and the result was good in 77 per cent. After a third operation the proportion of good results was improved to 88 per cent.Second recurrence occurred in I of 43 patients after revagotomy and gastrectomy, in 2 of 28 after resection alone and in 6 of 33 after vagotomy or revagotomy alone (P<0.05). When the patients whose primary operation included neither vagotomy nor gastric resection were excluded, there was a similar trend but the diferences were not significant. It is suggested that gastric resection or re-resection should be combined with vagotomy or revagotomy whether the primary operation has been gastrectomy, vagotomy with or without drainage or gastrojejunostomy alone.

Reoperation for recurrent peptic ulceration

“…While second operations for recurrent ulcer have achieved ulcer heahng in 34 (89 per cent) of our patients 9 (24 per cent) have needed additional procedures, and despite this only 24 (63 per cent) have finally obtained a satisfactory symptomatic result. Our results are similar to those of other workers (6)(7)(8).…”

Invited commentary

“…With this I would agree, although I think that revagotomy (truncal) should be added. We have had no deaths in 73 patients thus treated [8].…”