Document Detail


Emergency operations for gastric and duodenal ulcers in high risk patients.
MedLine Citation:
PMID:  3486644     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
With routine endoscopy, histamine antagonists, proximal gastric vagotomy (PGV) and declining prevalence of duodenal ulcers, morbidity and mortality of ulcer surgery should have declined. Two hundred thirty-four ulcer operations performed since 1976 were compared with 778 between 1961 and 1971. The hospital mortality rate has increased from 2.7 to 14.5%. Increased mortality was related to a doubling of the rate of emergency operations over age 50 and to a 94% decline in elective operations under 50. Mortality was increased by the need for emergency operations and more by concurrent diseases than by old age. Few operations could have been avoided by earlier elective surgery. Most perforations and hemorrhages occurred from previously unsuspected ulcers, many in patients being treated for other advanced or terminal diseases. Although most deaths occurred in this group, 42% survived. Such patients should be expeditiously offered the definitive operations most appropriate to the locations of their ulcers. Since 1976 among 200 survivors, 20 ulcers have recurred. Most recurred after PGV was tried for pyloric and prepyloric ulcers (8 of 16 recurred) and after previously untreated perforated ulcers were simply closed (4 of 11 recurred). The authors so far have one recurrence after 43 PGVs for duodenal ulcers. These recurrences confirm the need for vagotomy in perforated duodenal ulcer and for resection of ulcers proximal to the duodenum.
Authors:
H H McGuire; J S Horsley
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  203     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1986 May 
Date Detail:
Created Date:  1986-05-30     Completed Date:  1986-05-30     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  551-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Age Factors
Duodenal Ulcer / mortality,  surgery*
Emergencies*
Follow-Up Studies
Gastrointestinal Hemorrhage / etiology
Humans
Pneumonia / etiology
Postoperative Complications
Recurrence
Risk
Stomach Ulcer / mortality,  surgery*
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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