Introduction of proton pump inhibitors - Consequences for surgical treatment of peptic ulcer

BACKGROUND/AIMS: This retrospective study analyzes the influence of differe nt factors on morbidity and mortality after surgical treatment of peptic ul cer. METHODOLOGY: At the Municipal Hospital of Offenbach, Germany, from 1985-199 6, 485 patients underwent surgery. RESULTS: Of the 485 patients, 70.7% (343) were diagnosed to have duodenal u lcer and 29.2% (142) had suffered from gastric ulcer. During this period, 7 9.2% (384) of the operations were performed under emergency conditions beca use of acute complications (56% of these with perforation, 20% with penetra tion, 24% with ulcer bleeding), whereas the rest was done electively. Two h undred and ninety-one (60%) patients were male, the average age was 59 year s and 71.7% (348) of the patients had certain concomitant diseases. We obse rved complications: in 48% of the cases with a total postoperative mortalit y of 21%. CONCLUSIONS: Between 1985 and 1996 the total number of ulcer surgeries perf ormed at the Municipal Hospital Offenbach per year has stayed almost consta nt. However, a definite increase of acute operations in addition to a decre ase of elective interventions was noticed. The dissatisfying results of sur gical treatment of peptic ulcer after the introduction of proton pump inhib itors seems to be the consequence of the negative selection of patients men tioned above. A connection could be proved between the-age and condition of the patient, the type of the surgical intervention (acute or elective) and the morbidity and mortality after the surgery.