Twenty‐five years after Billroth II gastrectomy for duodenal ulcer

Abstract

One thousand twenty‐five patients underwent a Billroth II resection for duodenal ulcer between 1948 and 1956. The operative mortality rate was 2.4%. At follow‐up between 22 and 30 years later, 522 had died and 423 patients were traced. Recurrent ulcer appeared in 2.6% of the cases. Postgastrectomy symptoms occurred with the following frequency: dumping 10%, diarrhea 5%, vomiting 7%, and pain 4%. Anemia developed in 18%, hypoalbuminemia and hypocalcemia in 40 and 15%, respectively. Eleven percent had lost more than 10 kg in weight. Tuberculosis was found in 3% of the cases. While 90% of the patients were satisfied with the result, 10% were failures. The overall mortality rate was significantly increased because of suicide. Gastric carcinoma was the cause of death no more often than expected.

Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers

“…Most previous studies investigated the risk of suicide among peptic ulcer patients after surgical treatment and generally found an excess risk 8 9 10 11 12 13 14 15 16 17. Essentially, the results of the present study confirmed the excess risk of suicide among operated patients with peptic ulcer.…”

“…With regard to somatic illnesses, an excess risk of suicide has been found for neurological and neurodegenerative disorders4 and cancer 5 6. There are some reports of an excess mortality from suicide among patients with peptic ulcer both medically7 and surgically treated 8 9 10 11 12 13 14 15 16 17. However, few studies have explored the risk of suicide in gastric ulcer and duodenal ulcer patients separately, comparing before and after partial gastric resection or vagotomy.…”

Prognostic Factors in Gastric Stump Carcinoma

“…1 The incidence is reported to range from 2.4% to 5%. 2,3 Several studies have established an increased cancer risk in the gastric remnant. 4,5 Despite efforts to detect cancer early in patients who have undergone gastrectomy, the reported resectability rates at the time of diagnosis are approximately 40%, compared with 80% for patients with in primary gastric cancer.…”

“…3,6,22 However, the also high incidence of GSC (34.0%) with advanced disease (stage IIIb/IV) in our series worsens the prognosis in GSC patients. 6,[22][23][24] In some series, [2][3][4][25][26][27] approximately 90% of the GSCs occurred around the gastrojejunostomy and were caused by mucosal changes; the gastrojejunal anastomosis favored the Prognosis of Gastric Stump Cancer development of carcinoma. There is an abrupt transition between carcinoma located on the gastric side of the anastomosis and normal jejunal mucosa.…”

BPD and BPD-DS Concerns and Results

“…The bone problems caused by BPD do not seem to differ substantially from those reported in 25%-35% of postgastrectomy subjects with duodenal exclusion for peptic ulcer (Williams, 1964, Eddy, 1984, Fisher, 1984 and in one-third of patients with gastric bypass for obesity (Crowley et al, 1986). The mechanism is very likely a decreased calcium absorption causing an augmented parathyroid hormone (PTH) release which is generally sufficient to normalize serum calcium level at the expense of bone calcium content.…”