Graded gastrectomy for duodenal ulcer -- a five-year prospective study.

One hundred and twelve consecutive patients selected for surgical treatment for duodenal ulcer disease were treated by a graded gastrectomy according to the Moynihan modification of the Billroth II partial gastrectomy. A large partial gastrectomy (R) (2/3-3/4 gastrectomy) was done in patients who after maximal stimulation with histamine showed a high acid output (MAO greater than 30 mEa/hr), and a small resection (r) (1/3-1/2 gastrectomy) in low secretors (MAO less than 30 mEq/hr). The material was prospectively controlled by admission to hospital at 3 months, 1 year and 5 years postoperatively. The preoperative values of MAO found in R and r were 42.8 and 21.5 mEq/hr (p less than 0.001), respectively. The postoperative MAO values at the 3-month control were 4.5 and 3.0 mEq/hr by R and r, respectively, which shows that the grading of resection had been successful. Atrophic gastritis increased in frequency from 4% at the time of operation to 72% at the 1-year control...

Early colectomy in severe ulcerative colitis.

Before 1 February 1967 patients with severe attacks of ulcerative colitis were usually operated on after a prolonged period of medical treatment, and the mortality was 22%. During a 7-year period, beginning 1 February 1967, early colectomy has been perfomed in 21 patients with toxic megacolon and 58 patients with fulminating colitis. Immediate mortality in these 79 patients was 1.2% (one death). Two more patients died in connection with secondary operations. Thus the overall operative mortality in the present series was 3.7%.

Marital status and sexual adjustment after colectomy. Results in 178 patients operated on for ulcerative colitis.

The frequency of marriage and divorce did not differ from that of the general population. Female ileostomists married less often than females with ileorectal anastomosis (IRA) and had reduced fertility. Genital functional disturbance was not reported by the IRA males but occurred in 8 of 52 male ileostomists below 50. The coital activity, however, seemed undisturbed except for one married male. Dyspareunia was experienced by 8 of 15 IRA females aged 16-49 and intercourse triggered precipitancy in 2 of them. In a similar group of ileostomists only 5 of 50 had occasional dyspareunia. The coital practice and frequency in married patients did not seem to differ from a general population. Premarital activity seemed low in ileostomists of either sex. This as well as the low marriage rate in females may be ascribed to the psychological effects of a stoma and an appliance with contents.

Mental disorders in ulcerative colitis: suicide, divorce, psychosis, hospitalization for mental disease, alcoholism, and consumption of psychotropic drugs in 178 patients subjected to colectomy.

The population in the Nordic countries is relatively homogenous. In 178 Norwegian patients subjected to colectomy for ulcerative colitis the frequencies of suicide, divorce, psychosis, and hospitalization for mental disorders, and consumption of psychotropic drugs, did not differ significantly from corresponding frequencies in the general population.

Ileostomy in ulcerative colitis. Results in 149 patients.

The operative mortality among 144 patients treated with proctocolectomy and ileostomy for ulcerative colitis was 7.6%. Half the patients had fulminating colitis. Only 4 patients died during the follow-up period. Intestinal obstruction needing laparatomy occurred in 8.6%. Ileostomy revisions have been carried out in 13%, and significantly more often in females than males owing to a higher frequency of stoma retraction. Other ileostomy problems (leakage, skin soreness, excoriation) were experienced by nearly half the patients. These problems were episodic in the majority and could usually be remedied by instruction and new devices. Less than 7% used colostomy bags. In the remainder the changing interval appeared to be a measure of ileostomy success. The average length of the ileostomy spout was significantly longer in males without ileostomy problems (5.8 cm) than in males having leakage (3.7 cm). This difference was not apparent in females. Working and sexual impairment was rare. The success of an ileostomy depends on proper management, i.e., access to expert advice, instruction, training, follow-up, and adequate supplies of appliances. A stoma therapist on the staff is therefore extremely valuable.

Ileorectal anastomosis in ulcerative colitis. Results in 57 patients.

The early results of colectomy and ileorectal anastomosis (IRA) in 57 patients with ulcerative colitis seemed fair. The operative mortality was relatively low (7%) also in fulminating cases (10.5%), which constituted one-third of the material. The late results were less satisfactory. Half the survivors were in need of rectal extirpation and ileostomy because of rectal dysfunction. Until now 6% have developed cancer of the rectal stump. The early diagnosis of this condition was difficult. The results regarding rectal function, stenosis, and inflammation were significantly worse in women than in men. Moreover, dyspareunia was a severe problem in more than half the women. We have abandoned IRA in the treatment of ulcerative colitis.

Protectomy in ulcerative colitis. Results in 143 patients.

Secondary protectomy caused only one death in 59 patients while 10 deaths in the other 84 patients could be ascribed to simultaneous procedures such as colectomy. The perineal would was closed round a drainage tube. Healing was unrelated to age, primary or later protectomy, and corticosteroid medication. Mean healing time was significantly shorter in females (5.5 months) than in males (6.7 months). Only 50% of the patients reported healing in 6 months, and 20% still had an open wound at follow-up. These facts suggest that the present method should be altered. Healing seemed to follow an exponential curve, a trend which could be broken by revision, which was successful in 14 of 25 cases. Non-absorbable material, probably originating from ligatures on the superior hemorrhoidal vessels, was the apparent cause of sinus in 5 cases at least. Low as opposed to high ligation gives a long vascular pedicle, which may descend with its ligatures. This may explain the slower healing after protectomy for ulcerative colitis than for cancer.