Vagotomy or Gastrectomy for Gastric Ulcer

Duthie, H. L.; Kwong, Norra

doi:10.1136/bmj.4.5884.79

Cited by 40 publications

(12 citation statements)

References 7 publications

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“…Data from several countries show that ulcer disease is an important source of mortality, morbidity, and economic loss (Watkinson, 1960;Avery Jones and Gummer, 1960;Stanford Research Institute, 1977) and several publications showed a good result that can be obtained surgically with minimal mortality (Callum and Talbot, 1973, Duthie and Kwong, 1973, Nielsen et al, 1973. On the basis of the latter information and the data presented in this study, it can be strongly recommended that every ulcer be completely healed.…”

Section: Discussionmentioning

confidence: 99%

Effect of ulcer healing on the prognosis of chronic gastric ulcer: Four-year follow-up

Piper¹,

Shinners²,

Greig³

et al. 1978

Gut

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SUMMARY Eighty three patients were followed-up for four years after an admission to hospital with a chronic gastric ulcer proven by radiology (index ulcer). The index ulcer healed completely in 50 patients, but was unhealed at the time of discharge in the other 33. Significantly fewer patients whose index ulcer was healed compared with those whose ulcer was unhealed at discharge had had a recurrence by one (p < 0 05), two, three and four years' (p < 0 01) follow-up. Moreover, the rate of recurrence was significantly greater for those patients with unhealed, compared with those with a healed index ulcer (p < 0-05) and by the end of the four-year period 61 % of patients with unhealed, compared with 26 % of those with healed index ulcers had had a recurrence. Patients over the age of 60 years with unhealed index ulcers had a significantly poorer prognosis than those of similar age whose index ulcer was healed at discharge (p < 0 025). The sex of the ulcer patient did not significantly influence ulcer recurrence. Large ulcers (> 57 mm2) were less often healed on initial discharge and were more frequently associated with recurrence at one (p < 0 05), two (p < 0.025), three and four years (p < 0 01) than smaller ulcers (t< 57 mm2). Heavy intake of analgesics adversely influenced the course of patients whose ulcer was unhealed (p < 0 05), but did not alter the recurrence rate in those whose ulcer was healed. Ulcer recurrence was not influenced by smoking habits or by alcohol consumption.Hospital admission has been shown to have a beneficial effect on the rate of healing of chronic gastric ulcers (Doll and Pygott, 1952;Herrmann and Piper, 1973), but the value ofshort-termhealingon the long-term prognosis has been little investigated. We have recently demonstrated that up to two years after an admission to hospital for chronic gastric ulcer, patients whose ulcer had been healed at the time of discharge did better, having fewer recurrences and admissions to hospital than those whose ulcer was unhealed when they left hospital . The present study reports the comparative outcome for these groups during the four 'Address for reprints: Professor

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Section: Discussionmentioning

confidence: 99%

Effect of ulcer healing on the prognosis of chronic gastric ulcer: Four-year follow-up

Piper¹,

Shinners²,

Greig³

et al. 1978

Gut

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“…If we accept the findings of Emery and Monroe (1935) that approximately 2-4% of gastric ulcer patients died of their complications over an average period of 3 9 years (similar and higher mortalities have been reported by other workers, reviewed by Dworken et al, 1957), the emphasis must be placed on the necessity for complete healing if an acceptable mortality, and likewise morbidity, is to be obtained. This is particularly so when, in skilled hands, surgical treatment of gastric ulcer carries a mortality of 0-2% (Callum and Talbot, 1973;Duthie and Kwong, 1973;Nielsen, Amdrup, Christiansen, Fenger, Jensen, Lindskov, and Nielsen, 1973). It is our cuffent policy to heal all gastric ulcers completely by medical means (hospital admission or carbenoxolone sodium) and if the lesion recurs within two years surgery is advised (Piper, Coupland, Fevre, Hunt, Kasumi, Nagy, and Wood, 1974).…”

Section: Cigarette Smoking and Analgesic Ingestionmentioning

confidence: 99%

Factors relevant to the prognosis of chronic gastric ulcer.

Piper¹,

Greig²,

Coupland³

et al. 1975

Gut

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SUMMARY The factors that determine the recurrence rate of chronic gastric ulcer were studied in 105 patients. It was found that complete healing of the ulcer significantly reduced the recurrence rate and subsequent need for hospital admission because of ulcer symptoms when this group was compared with those who left hospital with their ulcers unhealed. Those admitted with large ulcers also had a higher recurrence rate. The age and sex of the patient, ingestion of analgesics and cigarette smoking did not influence recurrence. The initial healing rate of the ulcer also had no effect on the subsequent course of the patient.

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“…They found a recurrence rate of 10 per cent after vagotomy and pyloroplasty and 4 per cent after Billroth I gastrectomy (Duthie and Kwong, 1973). There were no operative deaths in either group but significantly greater operative morbidity occurred after Billroth I gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The operative mortality may be low in specialized units but the accepted world mortality rate is of the order of 2 per cent (Baron and Spencer, 1976;Johnston and Goligher, 1976) and may reach 4-5 per cent even in good units (Louw and Marks, 1977). The reported recurrence rate is at least 2 per cent and may reach 4-6 per cent (Johnson and Judd, 1971;Duthie and Kwong, 1973;Neilsen et al, 1973).…”

Section: Discussionmentioning

confidence: 99%

Vagotomy and pyloroplasty for gastric ulcers

Eastman

Gear

1979

Journal of British Surgery

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Eighty patients with benign gastric ulcer treated by vagotomy and pyloroplasty in a district general hospital are reviewed. There were no postoperative deaths in the patients undergoing elective surgery but 8 deaths in those undergoing emergency surgery for massive bleeding (38 per cent). Eighty-three per cent of patients had a result that was classed as good or satisfactory. Recurrent gastric ulceration was found in 8 per cent and a tendency to late asymptomatic ulcer recurrence is identified. Careful long term follow-up, including endoscopic re-examination, is advocated for patients undergoing conservative operations for benign gastric ulcer.

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Vagotomy or Gastrectomy for Gastric Ulcer

Cited by 40 publications

References 7 publications

Effect of ulcer healing on the prognosis of chronic gastric ulcer: Four-year follow-up

Effect of ulcer healing on the prognosis of chronic gastric ulcer: Four-year follow-up

Factors relevant to the prognosis of chronic gastric ulcer.

Vagotomy and pyloroplasty for gastric ulcers

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