CHANGES IN SURGICAL STRATEGIES FOR PEPTIC-ULCERS BEFORE AND AFTER THEINTRODUCTION OF H-2-RECEPTOR ANTAGONISTS AND ENDOSCOPIC HEMOSTASIS

A total of 902 surgical patients with peptic ulcer disease were evalua ted to clarify the effects of H-2-receptor antagonists and endoscopic hemostasis on surgical treatment. Following the introduction of these treatments to our institute in 1982, the number of operations performe d annually decreased by 40%, or 36 cases per year. However, a remarkab le increase in the frequency of surgical emergency intervention since 1982 was concurrently observed, with the ratio of emergency procedures to the total number of operated cases increasing to 72.5% in the last 5 years of the study. Moreover, intractability as an indication for s urgery decreased to 34.1%, compared with an increase in the number of patients with bleeding and perforated ulcers requiring operation. Ther e were 13 postoperative deaths recorded (1.4%). All of the deaths were in patients who had undergone emergency surgery in poor health. Of th ese 13 patients, 10 had bleeding ulcers. A study of bleeding ulcers fo r which endoscopic hemostasis had been unsuccessful revealed that shoc k on admission and a concomitant medical condition had been evident in all the patients who died, and in 52.2% and 30.4% of the survivors, r espectively. The current study suggests that the frequency of high-ris k patients requiring surgery is increasing since the introduction of H -2-receptor antagonists and endoscopic hemostasis, and thus, prompt su rgical treatment and intensive management for such patients is essenti al.