THE RESULTS OF OPERATIONS FOR PEPTIC ULCER: AN INVESTIGATION OF CASES OVER A TEN‐YEAR PERIOD AT THE ROYAL MELBOURNE HOSPITAL1
Authors: Lawson Robert S. 
Published: January 2008

Summary

1. A review is given of all operations performed for peptic ulcer at the Royal Melbourne Hospital over the ten‐year period 1927 to 1937. These include operations of election for duodenal and for gastric ulcer, operations for pyloric stenosis and hour‐glass stomach, and operations for hsematemesis and for jejunal ulcer. An attempt has been made to trace the end‐results in all patients surviving.

2. Operations for perforation of a peptic ulcer have been reviewed over a period of five years only (1932 to 1937), and only the immediate results lwive been considered in regard to these cases.

3. Operations of election were performed on 115 patients for chronic duodenaL ulcer, posterior gastroenterostomy being performed in 97 cases. The operative mortality of gastroenterostomy in these cases was 4%. The end‐results among patients traced reveal that 65% of the survivors were benefited by operation, while 15% developed jejunal ulcer.

The prognosis after operation is shown to be better for patients with some degree of duodenal stenosis or with a low gastric acidity. The prognosis appears to be worse for patients having a high gastric acidity.

The results of other operations for duodenal ulcer are given, including ten additional cases in which chronic duodenal ulcer and cholecystitis were present.

4. Operations of election were performed on 126 patients for chronic gastric ulcer. Gastroenterostomy was performed in 62 of them with an operative mortality of 8%. Of the survivors, carcinoma is known to have developed in three. The end‐results among other patients traced reveal that 80% of patients were benefited by operation and that jejunal ulcer developed in 6%.

The results of gastroenterostomy in cases of lesser curve ulcer appear to be better than in cases of prepyloric ulcer, especially when combined with excision of ulcer.

Partial gastrectomy was performed as the primary operation in 37 cases with an operative mortality of 30%. All surviving patients traced were benefited by operation.

Simple excision of lesser curve ulcer was performed in 12 cases with an operative mortality of 25%. Secondary operations performed on these and other patients with gastric ulcer are described.

5. Operations for pyloric stenosis were performed on 15 patients. The immediate and end‐results in these cases are given.

6. Operations for hour‐glass stomach were performed on seven patients. The operations performed and the end‐results are described.

7. The end‐results of gastroenterostomy performed for any of the above classes of condition have been collected. One hundred and sixteen such patients have been effectively traced; 74% of these were benefited by operation, while a jejunal ulcer developed in 9‐5%.

8. In regard to gastro‐duodenostomy, pyloroplasty and pyloric exclusion, the number of these operations performed was few (only 28 for all classes of case). The results were indifferent.

9. Twenty‐one cases of jejunal ulcer which came under observation during the ten‐year period are reviewed. In 14 of these, operations were performed for the cure of the condition, and these are described with their results.

10. A brief description is given of 12 additional cases in which recurrence of a peptic ulcer (in the same or in a new situation) is known to have occurred, and of a number of others in which a recurrence can be reasonably presumed.

11. Operations for the control of hsmatemesis were performed on 18 patients. Only four of these patients survived. The details of these cases are given.

12. Two hundred and thirteen patients with perforated peptic ulcer were admitted to the hospital during the five‐year period 1932 to 1937. Oversewing of the ulcer was performed in 197 of these cases with an operative mortality of 25 %. The mortality among all patients admitted was 30%. The results in relation to the age of the patient and the duration of the perforation are given.

13. It is submitted that peptic ulceration is a constitutional disease essentially running a natural course irrespective of treatment.