Palliative Gastrectomy in Selected Cases of Gastric Ulcer

Abstract

CHRONIC BENIGN ULCERS high on the lesser curvature of the stomach and those juxta-esophageal in position have always presented technical problems in their surgical management. A multiplicity of procedures has been advocated. At first, these operations were designed to relieve the gastric retention secondary to a reflex pylorospasm. However, gastrojejunostomy, usually without the local excision of the lesion, even though it relieves the obstruction, has been found to be an unreliable and ineffectual operation in most * Read before the American Surgical Association, April 2-4, I946, Hot Springs, Virginia.

High gastric ulcer

“…Others [3,4] also describe a higher incidence among women and this corresponds to reports of an increasing incidence of perforated gastric ulceration in women while the incidence in men is tending to fall [5,6]. In one series, however [7], the HGU patients were mostly men. The mean age of our patients was 66 years and 20% of them were older than 75 years.…”

“…We found that almost 40% of the ulcers were deeply penetrating into surrounding structures and the figure may be as high as 100% [7]. The importance of this will be discussed later.…”

“…There were 5 patients with signs at operation of current or previous duodenal ulcers. Others found that 25-50% of their patients with HGU had concomitant signs or previous symptoms of duodenal ulcers [7,8,19]. This is somewhat in contradiction to the statement [4,8] that all patients with HGU have hypoacidity.…”

“…This procedure has the advantage of being relatively easy since the HGU is left in situ while, at the same time, being a definitive ulcer operation. Colp and Druckerman [7] reported good results as far as ulcer healing and ulcer recurrence rates are concerned, but there was considerable mortality and morbidity. Missed cancers were not seen.…”

Subtotal Gastrectomy for Gastric Ulcer

“…Gastric ulcer is characterized by certain features which are lacking in duodenal ulcer and which exert an important influence upon the -management of the disease. These several peculiarities may be' summarized briefly as follows: (i) the existence of ulcer, its exact location, size and other characteristics can be demonstrated by roentgenologic examinations and/or gastroscopy in a high percentage of cases; (2) the response to treatment may be very accurately followed and recorded by these same methods; (3) it is often closely mimicked by primary ulcerating carcinoma; (4) carcinomatous degeneration may occur as a late complication of an originally benign chr-onic gastric ulcer; (5) surgical intervention is required in a larger percentage( of cases than in the case of duodenal ulcer; (6) practically all surgical procedures, including the simpler ones, will substantially reduce the gastric acidity; (7) the clinical results of operative treatment are better than in duodenal ulcer and (8) anastomotic ulcer is a rare complication following gastroenteric anastomoses for gastric ulcer.…”