Surgical survey of peptic ulcer in South India

Abstract

SUMMARY Between 1944Between and 1960Between , 1138 consecutive patients operated on in the Christian Medical College Hospital, Vellore, for peptic ulcer were documented. Deaths within I month of operation gave an overall mortality of 3.3 per cent. Six hundred and seventy-eight patients with duodenal or gastric ulcer were operated on by one of three standard procedures, and were followed up for 5 to 15 years after operation. Relief of symptoms was obtained in 80 per cent of patients. Vagotomy and gastrojejunostomy was found to be the best standard operation.PEPTIC ulcer first appears in Indian writings in a description by Madhavakar in the seventh and eighth centuries A.D. from central India (Sehgal, 1962). He wrote of 'pain which occurs at the time of digestion of food called " parinam shool" (resultant pain) '.In India in the early twentieth century, symptoms of peptic ulcer were diagnosed as 'dyspepsia'. As recently as 1936, reference was made to the rarity of peptic ulcer in India (Rogers and Megaw, 1935).However, in 1936 Somervell and Orr stated: 'socalled peptic ulcer is very common in the south of India'. Today it is accepted that peptic ulcer occurs commonly throughout the country.Gastrojejunostomy for the surgical relief of peptic ulcer was first performed in India by Niblock in Madras in 1905 (Dogra, I940a), 12 years after the operation had first been described (Olch and Harkins, 1962). This paper reports the results of a follow-up study of patients with peptic ulcer who were operated on in the Christian Medical College Hospital between the years 1944 and 1960. A preliminary communication on some of these cases has been published (Hancock, 1960). MATERIALS AND METHODSThis study includes 1138 patients living within a Ioo-mile radius of Vellore who were operated on for peptic ulcer up to the end of 1960. Of these, 326 patients could not be traced after discharge from hospital. Statistical analysis of the records showed that these patients did not differ significantly from the remainder and it may be concluded that those available for follow-up study (812) were a representative sample of the whole. Of the 812 patients, 38 died within I month of operation (3.3 per cent), and 48 died at some time during the subsequent 5 years. The remaining 726 patients were studied at varying intervals from 5 to 15 years after operation.Information concerning the patient, the type of ulcer, 23 a stomal ulcer, and 16 had two or more ulcers in different sites (TabZe I ) . The patients with stomal and multiple ulcers (39) were considered to be too few in number for statistical analysis. The age distribution of the 687 patients with duodenal or gastric ulcer is shown in Fig. I. Three main types of operation were performed:-I. Simple gastrojejunostomy. A vertical anastomosis, which was usually retrocolic, was placed in the most devendent Dortion of the stomach. with the operation, and the postoperative course was recorded on a standard pro forma. Of the 726 patients, the majority (604) had a duodenal ulcer; 83 had a gastric j...