Related Experiment Videos
A thousand operations for ulcer disease
Insights
Surgical operations for peptic ulcer disease decreased significantly from 1974-1986, with fewer elective procedures but stable rates for emergency surgeries. Mortality rates varied by operation type, with organ failure and sepsis being leading causes of death.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Epidemiology
Background:
- Peptic ulcer disease historically required surgical intervention.
- The advent of cimetidine marked a potential shift in treatment paradigms.
- Understanding surgical trends and outcomes is crucial for patient care.
Purpose of the Study:
- To analyze trends in peptic ulcer disease operations over a 12-year period.
- To evaluate mortality rates associated with different surgical procedures.
- To identify early and late complications following peptic ulcer surgery.
Main Methods:
- Retrospective study of 1068 patients undergoing peptic ulcer surgery.
- Data collected from January 1, 1974, to January 1, 1986, at Massachusetts General Hospital.
- Analysis of admission rates, operation types, mortality, and complication rates.
Main Results:
- A 39.3% decline in peptic ulcer disease admissions and a 16.5% decrease in annual operations were observed.
- Elective duodenal ulcer operations showed the greatest decline; emergency operations for hemorrhage and perforation remained constant.
- Overall mortality was 10.3%, with significant variation based on surgical urgency and indication.
Conclusions:
- Surgical interventions for peptic ulcer disease decreased, likely influenced by medical advancements.
- Mortality risk is substantially higher for emergency and urgent procedures compared to elective ones.
- Key complications include organ failure, sepsis, early postoperative hemorrhage, and late recurrence, necessitating careful patient management.
Abstract:
A retrospective study of 1068 patients who had operations for peptic ulcer disease in the 12-year period from January 1, 1974, to January 1, 1986, permits these conclusions: The number of patients admitted to the Massachusetts General Hospital (MGH) has declined steadily in the years of this study--1974-1986. The average number of patients admitted with a diagnosis of peptic ulcer disease in precimetidine years--1974, 1975, and 1976--and in recent years--1982, 1983, and 1984--shows a decline of 39.3% in admissions. In the same periods, the average number of operations per year has declined from 92 in precimetidine years to an average of 71 (16.5%) recently. The decline has been greatest in patients operated on electively for duodenal ulcer. Operations for massive hemorrhage and acute perforations and the number of deaths have remained nearly constant. The overall mortality rate was 10.3%. The mortality following elective operations for pain was 0.5%; for urgent operations, including those for obstruction, 4.5%, and for bleeding other than massive, 7.5%; and for emergency operations, including those for acute perforation, 20.9%, and for massive hemorrhage, 22.1%. The main causes of death were organ failure (most commonly of the lungs) and sepsis. Early complications were documented 345 times and were followed by reoperation in 84 cases, or 7.4% of the total. Delayed stomal function was noted in 63 cases and required reoperation in 14. It was most common after Roux anastomoses and required operative intervention most commonly after gastric resection, Billroth I (GRBI). Delay was three times as common when vagotomy (V) was added to GR. Early postoperative hemorrhage was a serious complication when it occurred after operations for acute perforations or massive hemorrhage. The incidence was 3.7% after suture of a perforation; after operations for acute massive hemorrhage, it was 4.3% after pyloroplasty and vagotomy, with or without arterial ligation [PV(L)], and 0.3% after GR, with or without arterial ligation [GR(L)]. Late complications led to reoperation in 66 cases (6.2%). The most important were recurrent ulceration and alkaline gastritis. Recurrence rates after a minimum follow-up of 5 years (based on survivors of initial procedures and a second operation, both in the MGH) were 20.5% after suture of a perforation, 6.2% after PV, 2.3% after GRBII, and 0.4% after GRVBII. These figures are lower than expected; incomplete follow-up and improved medical care are factors.(ABSTRACT TRUNCATED AT 400 WORDS)