Recurrence of peptic ulcer after selective proximal vagotomy and pyloroplasty in relation to changes in clinical signs and symptoms between 1969 and 1983.

ABSTRACT

Only those patients who were examined endoscopically were evaluated. Concomitant examinations, such as biopsy, histologic studies, roentgenograms, scintiscanning, acid secretion, serum gastrin and review of the operative reports, were done. Duodenal ulcers (1,219) and gastric ulcers (421) were examined preoperatively. Of these, selective proximal vagotomy and pyloroplasty and excision of the ulcer were performed for 1,018 duodenal ulcers. Forty-three per cent were examined postoperatively. Selective proximal vagotomy and pyloroplasty and excision of ulcer were performed for 315 gastric ulcers. Thirty-nine per cent were examined postoperatively. Recurrence was calculated in relation with the patients examined postoperatively. Recurrence of duodenal ulcer occurred in 6.3 per cent; of these, 0.9 per cent had duodenal ulcers develop into gastric ulcers. The recurrence rate of gastric ulcer is 8.1 per cent; of these, 0.8 per cent developed into duodenal ulcers, and 0.8 per cent to carcinoma of the stomach. Data of recurrent ulcers were compared with the data for the total number of patients who underwent surgical treatment. The possible causes for a recurrence are demonstrated. In duodenal ulcers, 79 per cent of recurrences are due to technical error (inadequate vagotomy and incomplete drainage); in gastric ulcers, 90 per cent of recurrences are due to technical error. In both duodenal and gastric ulcers, causes are partly based on advanced clinical symptoms. Recurrence rates showed a tendency to increase between 1969 and 1975 and 1976 and 1983. This correlated directly with the deterioration of the clinical signs and symptoms between 1969 and 1983, shown in increased acid secretion, increase and shift of ulcers and stenoses, increase in bleeding and changed epidemiologic findings.