Elective procedure for peptic ulcer: a disappearing operation.

Abstract

We retrospectively reviewed all the operative procedures performed for benign peptic ulcer disease in a regional hospital during the past 6 years. The indications were hemorrhage, perforation, obstruction, chronicity, and gastrocolic. No operation for chronicity has been performed since 1986. Only in perforation was there a statistical difference between male and female. Two hundred forty-six patients were admitted for bleeding, 108 were given transfusions and 38 required operative intervention for control of bleeding. The average units of blood given to patients with bleeding, who underwent operative intervention and recovered, was 7.2. The 6 deaths in this group were in patients who received 15.7 units of blood. Of these, none survived. Twenty patients with perforated ulcers were successfully treated with gastric resection with vagotomy. One patient with a perforated ulcer had primary suture repair, another had vagotomy and pylorplasty. Both required gastric resection because of obstruction and reperforation, respectively. Gastric resection with truncal vagotomy successfully corrected obstruction in 18 patients and chronicity in 9 patients, without mortality. Death from hemorrhage is directly related to delay in operative intervention. With the availability of effective medication for control of gastric acidity, the need for selective vagotomy or elective operative procedure for ulcers is fast disappearing.