Psychological factors, operative procedures, and results of surgery for duodenal ulcer.

Abstract

The long-term outcome of surgery for peptic ulcer has been the subject of many investigations, most of which relate to recurrent ulceration, alimentary symptoms, and impaired nutrition. The study reported in this paper is concerned with the effect of psychological factors on the outcome of surgery. Surgeons have always recognized the importance of selecting the right patient for surgery ('do-ers and non-do-ers') but the significance of these factors has not been adequately assessed.The hypothesis tested in this investigation was that patients with bad postoperative results have abnormal personality and mood disorders before surgery.Standard techniques to measure certain aspects of personality and mood were used to evaluate the outcome of two different operations, to explore the relationship between symptomatic results and these psychological factors, and to seek the existence of psychological changes before operation and their effect after surgery.CLINICAL MATERIAL POSTOPERATIVE PATIENTS The basis of the study was a long-term, prospective investigation started in 1954 in the Peptic Ulcer Clinic at the Western Infirmary, Glasgow. In this project, male patients coming to elective surgery for chronic duodenal ulcer were treated either by a Polya partial gastrectomy or by total vagotomy with gastrojejunostomy. The choice was made randomly only after the surgeon had completed his preliminary laparotomy and satisfied himself that he could carry out either operation with complete safety.The present study includes only those patients who had been operated on at least eight years previously. The percentage follow-up of the total number of available patients was 82 in the Polya group (56 patients) and 84 in the vagotomy group (51 patients). Personality testing was carried out in 39 patients in the Polya group and in 37 patients from the vagotomy group, all selected The unoperated patients were an unselected series of chronic duodenal ulcer patients who presented for preliminary investigation during the follow-up of group A. Seventy-eight male and female patients in all were studied, but in order to make a comparison with the group A patients (all males), the male unoperated patients were examined separately and are subsequently referred to in the test as group B. Sixty-six of the total preoperative patients (males and females) were followed up immediately after surgery to assess the physiological completeness of vagotomy and to see if, using insulin tests, secretion of acid related to preoperative personality. These are subsequently referred to as group C patients. METHOD OF STUDYPersonality was measured by means of questionnaires which were given to the patients with the explanation that we wished to investigate certain aspects of personality in their condition. Two questionnaires which have been standardized for large groups of normal individuals were used. EYSENCK PERSONALITY INVENTORY (EPI forms A and B)The EPI (Eysenck and Eysenck, 1964) is a development of the Maudsley personality inventory (Eysenck, 1959) and gi...

Psychiatric disorders after surgery for duodenal ulcer

“…This has been noted by others (Glen and Cox, 1968) and was the most frequent complication found in the original study (Sinclair-Gieben et al, 1962). In the previous study, however, it appeared to be confined to obsessional patients but this has not been borne out by the present investigation.…”

“…In the early study patients with partial gastrectomy and patients with perforated peptic ulcer formed the study group, and the inclusion of the latter may have introduced some errors. The present study was confined to patients treated by vagotomy and gastroenterostomy (two patients with pyloroplasty) but there is no difference in the incidence of unsatisfactory surgical results between this operation and partial gastrectomy (Glen and Cox, 1968). It can be concluded that the results of surgery for duodenal ulcer in patients with an obsessional personality are in no way inferior to the results in other patients.…”

“…Attempts to extend these observations to the aetiology of peptic ulcer, however, have met with little success (Roth, 1955;Kessel and Munro, 1964). Although no evidence has been found to support a psychosomatic cause for duodenal ulcer the relationship between psychological factors and the results of surgery show some interdependence (Pascal, Thoroughman, Jarvis, and Jenkins, 1966;Glen and Cox, 1968) and this may have a bearing on selecting suitable cases for operation. Sinclair-Gieben, Clark, and Dean (1962), in a retrospective study, found that patients with an obsessional personality were more liable to psychiatric breakdown if their ulcer symptoms were relieved by operation.…”

The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

“…In both studies half the patients had neurotic traits, one‐fifth showed other personality disorders and one‐third were without psychiatric symptoms. Accordingly, several studies using either clinical interview or psychometric test or both in the personality assessment indicate that neuroticism is a predominant disorder in peptic ulcer patients [1–5, 8]. Objection could be made against the general validity of these results that they were found in patients admitted to hospital, i.e.…”

“…The outcome of medical and surgical treatment for peptic ulcer in relation to personality has also been the subject of many investigations which have established a distinct relationship between personality disorders and treatment failure [6–10].…”