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KMID : 0371319610030020045
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Journal of the Korean Surgical Society
1961 Volume.3 No. 2 p.45 ~ p.51
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Surgical treatment of benign peptic ulcer
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Roberta, G. Rice
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Abstract
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This report is a review of our experience with 121 cases of benign peptic ulcer which were treated surgically at the Severance Hospital, Yonsei University, from January, 1955 to June, 1960.
There is still considerable controversy about the indications for surgery in patients with benign peptic ulcer. It is generally accepted that the lesion is a medical problem which must be treated conservatively unless complications develop such as acute perforation, obstruction, bleeding, or a questionable malignant change. Also, it is generally believed, intractable pain is an indication for surgical treatment. Because of the high incidence of carcinoma among -lesions along-the greater curvature of the stomach Among these cases the ratio of complication to some doctors advise surgical exploration if the lesion non-complication was 9 - 1-as an indication for surgshows no response after three weeks of medical treaty. Thus the uncomplicated cases usually do not atment. ome to surgery_ either because the patient refuses
The lesions were divided into three groups accor- surgery or surgical consultation is not requested. According to the location of the ulcer at surgery and on The mortality was 4.01 % for all 121 cases and pathological examination. 52.9% of the ulcers were was highest for those who had a perforation which gastric, 22.4% were pyloric, and 24.8% were duode- was treated with simple closure(9. 1%). Where thenal in location. This incidence of ulcer location is in patient was treated with an immediate gastrectomy
direct opposition to the incidence which is usually the mortality was only 1.9%.
reported in. the United States. We have found the Because of the high incidence of postoperative stomach to be a common site for ulcer perforation complications with simple closure of the perforated (62%). Some reports from Japan show similar find- ulcer, and because of the lower mortality with ings. It is suggested that differences in the quality gastric resection, we advise immediate subtotal and quantity of food intake might explain the diffe- gastrectomy where possible in the treatment of perrence in ulcer location. forated peptic ulcer. As for the surgical indications in our 121 cases: Among 86 cases of perforated peptic ulcers we 71% were for perforation, 20% because of obstruction found 2 to be carcinomatous, and among 83 cases, 6.5% because of intractable pain and possible of clinically benign peptic ulcers we found six´ to be malignant change, and 2.5% because of hemorrhage. malignant.
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