[Late complications after surgical operations in gastroduodenal ulcer (emergency operations)]

A clinical study is presented, concerning the lated disturbances noted in 61 patients hospitalized as emergencies, and operated for complicated gastroduodenal ulcer (with perforation, and/or haemorrhage) between 1969 and 1973. The control of the patients was made in the ambulatory, 50-10 years after they had underwent surgery. Late postoperative disturbances were investigated from the clinical, radiologic, biochemical and histologic viewpoints, and the results were correlated with the anatomo-pathologic aspects of the ulcerative lesions, and with the type of the intervention performed: gastroduodenal resections followed by gastroduodenoanastomosis of the Péan type, or gastroenteroanastomosis of the Reichel-Polya type; antrectomy with gastroduodenoanastomosis, and vagotomy; excision of the ulcer, with vagotomy and pyloroplastia. The analysis of the cases allowed for the following conclusions: when the local condition permits it is recommended that, after resection, gastroduodenalanastomosis should be performed from the start; in the young patients, with recent ulcers, on the anterior aspect of the duodenum, and complicated by perforations (with a small diameter of 0,2-0,3 mm), or with haemorrhage, excision of the ulcer and vagotomy should be performed, and pyloroplastia. With regard to vagotomy the authors recommedn, when possible, to prefer the selective type instead of the troncular. Gastric resection should be as economical as possible, and gastrectomy should be acoided when such an indication is not absolutely indispensable. In ulcers located in the antrum, or in pyloroduodenal ulcers, the authors preferred to perform antrectomy and gastroduodenalanastomosis, associated to selective or troncular vagotomy. Patients that have underwent gastroduodenal resection should be dispensarized and monitored, at least in the first 2 years after the intervention, since in this interval they may present complicating that could be avoided.