OPERATIONS FOR GASTRIC-ULCER - A LONG-TERM STUDY

This study assesses the long-term results of operations for benign gas tric ulcers. Three-hundred forty-nine patients operated upon between 1 950-1979 have been followed over the past 20 years with a mean and med ian follow-up of 11.8 and 11.1 years. Fifty-five per cent of the patie nts had a gastric resection without vagotomy; 19.8 per cent had gastri c resection with vagotomy; and 20.3 per cent had vagotomy, pyloroplast y, and wedge excision or biopsy of the ulcer. Operations were selected based on the type of ulcer (Types 1-4), whether the surgeon suspected cancer preoperatively, whether the operation was elective or an emerg ency, and the age and general health of the patient (presence of signi ficant co-morbid disease). Overall mortality was 6.9 per cent, with a mortality for elective operations of 3.6 per cent, and for emergency o perations of 32.5 per cent. Age and cardiovascular disease were signif icant factors in operative mortality and morbidity. All operations wer e equivalent in long-term results. Excellent to good results were obta ined in 92 per cent of patients, with an ulcer recurrence rate of 4 pe r cent. We conclude that vagotomy, pyloroplasty, and wedge excision or biopsy of a benign gastric ulcer is a comparable operation to a more major gastric resection, with or without vagotomy, in the surgical man agement of gastric ulcer. The addition of vagotomy to gastric resectio n does not appear to improve long-term results.