Fistulas following gastrectomy

Postoperative fistula occurred in 16 of 761 cases in which subtotal gastrectomy was done. Twelve of the 16 patients died. In the majority of cases complications arose because of the anatomical location of the ulcer with surrounding inflammation. Abrupt and dramatic onset of symptoms following leakage occurred in only a few cases. Perforation occurred in a few cases after the patient had been discharged home well and asymptomatic. Obstruction of the proximal limb was not present in any of the cases in which postmortem examination was carried out. The exclusion operation with resection of antral mucosa may not be a safe procedure. For treatment of ulcer which cannot be removed, gastroenterostomy with vagotomy is advised.