Surgery and the patient with intractable peptic ulcer

Thoroughman, J. C.

doi:10.1016/0002-9610(63)90345-3

Cited by 10 publications

(2 citation statements)

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“…Studies using psychological factors as predictors of outcome following surgery have been reported by Thoroughman (1963) and Pascal, Thoroughman, Jarvis, and Jenkins (1966). In these studies, life history factors have been scored preoperatively using a deprivation scale devised specifically for Psychological factors, operative procedures, and results of surgery for duodenal ulcer 671 ulcer patients and the scores obtained used to predict outcome at a three-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

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

Glen¹,

Cox²

1968

Gut

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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...

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Section: Discussionmentioning

confidence: 99%

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

Glen¹,

Cox²

1968

Gut

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“…The difficulties inherent in selection for further surgery in these patients have already been discussed (Buchan, Clark, and Downie, 1965) but there is a tendency for many surgeons to regard the bad results of surgery as a defect inherent in the patient rather than in the operation. Thoroughman (1963) has examined this problem, and, using psychological techniques and a scoring system, he has made predictions of the outcome of operation in a prospective study which shows a significant relationship with the results of surgery (Pascal et al, 1966 -Gieben et al, 1962). A hypothesis was considered that the obsessional patient was in some way dependent on his ulcer symptoms and consequently if his symptoms were relieved by operation he would be prone to psychiatric illness.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric disorders after surgery for duodenal ulcer

Mason¹,

Clark²

1970

Gut

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LondonSUMMARY A prospective trial was conducted to determine the relationship between personality type and the results of surgery for peptic ulcer. Previous investigations had suggested that patients with an obsessional personality fared less well than those who were not obsessional. However, although there was a high incidence of psychiatric disorders in these surgical patients no significant difference was found between the two groups. It was concluded that classifying patients as obsessional and non-obsessional did not have any bearing on the outcome of operation.The psychosomatic theory of the aetiology of duodenal ulcer probably stems from the observations of Beaumont (1833) who studied the gastric mucosa through a gunshot wound fistula in his patient Alexis St. John. The marked changes in the vascularity and secretion of the stomach found in response to induced changes in mood provided direct evidence that an association existed. 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. This finding was so remarkable that a prospective study was begun in 1962. Sufficient time has now elapsed to assess the results. MethodsA series of 100 patients admitted to hospital for elective surgery for duodenal ulcer were examined by a psychiatrist. An objective rating scale based on the Minnesota multiphasic personality inventory was used, principally to determine aspects of mood, and personality was determined by specific questions (Sinclair-Gieben et al, 1962) modelled on Schneider's (1958) concept of anencastic personality. On this basis the patients were allocated either to an 'obsessional' or 'nonobsessional' group. Where there was doubt the patient was regarded as non-obsessional. These ratings, together with the comments of the psychiatrist, were not seen by the surgeon performing the operation, and were filed away until the final assessment some years later.The operations performed were vagotomy with gastroenterostomy, either ante-colic or retrocolic, in all but two cases where a pyloroplasty was perform-d. An attempt was made to see these patients in 1967, an average of four to five years after operation. The results of surgery were then examined in relation to the psychological grading. A note was made of any treat-

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Peptic Ulcer

Kirsner

1964

Gastroenterology

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Surgery and the patient with intractable peptic ulcer

Cited by 10 publications

References 5 publications

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

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

Psychiatric disorders after surgery for duodenal ulcer

Peptic Ulcer

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