Reoperation for recurrent peptic ulcer

The authors consider 74 patients who have undergone reoperation for recurrent peptic ulceration in their hospital, between 1971 and 1980. Recurrences followed gastrectomy (39 cases), vagotomy (33 cases) and gastroenteroanastomosis (GEA) (2 cases). The reoperations were: vagotomy or revagotomy; gastric resection or reresection; vagotomy combined with resection. Assessment of results was based on Visick clinical grading: 24 patients remained in Visick grade III and IV. Failure was due to a second recurrence in nine patients, who therefore underwent further operations, but two patients remained in Visick grade III and there was one operative death. The authors conclude that most patients end with both a vagotomy and a gastric resection and that the final postoperative results remain fairly poor in some cases. In attempting to cure recurrent ulcers most surgeons stress that reoperation is the treatment of choice, but all the surgical procedures are potentially difficult and therefore potentially dangerous. Nowadays, the results of medical management (cimetidine) seem satisfactory, but we must still fully evaluate the side-effects of the long-term maintenance treatment.