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PubMed1983

Recurrent ulcer after gastric surgery--prevention and management based on a local experience.

This paper reports a personal experience in the management of 45 patients with recurrent ulcer after gastric surgery. Inadequate acid reduction was the major cause of ulcer recurrence and treatment was by further acid reduction. Revisional surgery was performed in 23 patients (including a patient with a gastro-jejuno-colic fistula) with one mortality. Preliminary results of therapy with histamine H2-receptor antagonists have been encouraging and there appears to be a reduced need for re-operation in these patients in recent years. Less common causes of ulcer recurrence include retained suture material (2 cases) and the Zollinger-Ellison syndrome (2 cases). The incidence of post-surgical ulcer recurrence may be reduced by: improved surgical techniques, particularly in the performance of vagotomy, and avoidance of operations without acid reducing procedures e.g., gastro-jejunostomy without vagotomy; wider use of emergency ulcer curative surgery for perforated peptic ulcer. Experience at two local centres has been that this is a safe procedure in selected patients, there being no mortality in 58 cases. Routine screening of peptic ulcer patients for the Zollinger-Ellison Syndrome by measuring the serum gastrin level facilitates early diagnosis of the condition, thus forestalling gastric surgery and the inevitable recurrent ulceration.

Combined Modality Therapy↗
PubMed1994

[Laparoscopic suturing of a perforated gastroduodenal ulcer].

The mortality rate for perforated peptic ulcer ranges from 10 to 30%. Age above 70 years, preoperative shock, operation more than 24 hours from the time of acute onset, and poorly controlled concurrent illness are considered to be risk factors. Individuals with any of these features are deemed unfit for definitive surgery and should undergo simple omental patch suture alone. This case report details the laparoscopic management of an 86-year-old female with a ruptured duodenal peptic ulcer who was receiving corticosteroids and a non-steroidal antiinflammatory drug. Laparoscopy is of diagnostic value and permits efficient cleaning of the abdominal cavity. Provided the laparoscopic principles of management are essentially the same as those adhered to during open surgery, the minimally invasive procedure may help to reduce postoperative morbidity and mortality.

Aged↗