Surgical treatment of recurrent and stomal peptic ulcers

Twenty-three patients with endoscopically proved recurrences after a primary operation for peptic ulcer disease performed in the course of a 7-year period are reviewed. The time elapsed between the operation and the recurrence ranged from 1 year to 17 years. The patients were mainly males. During the period studied 451 primary operations for peptic ulcer disease were performed in the same department. In 12 out of 23 recurrences the primary operation was also performed in the department of the author. In cases of small duodenal or stomal ulcer with two or more previous laparotomies transthoracic truncal vagotomy is preferred to any kind of abdominal intervention. A useful combination of duodenal exclusion, truncal vagotomy and a reflux-preventing type of GEA for recurrences after B 1 type partial gastrectomies was developed. In cases of late recurrences with mild symptoms the patients have to be first treated with H2-receptor blockers (cimetidine, ranitidine, etc.). The cases resistant to medical management have to be considered for surgery. Their results after a secondary surgical intervention proved to be fairly good, probably due to methods adequately selected for the given patient and to reflux-preventing GEA used in some cases. The consideration of an optimal individual solution for each patient is emphasized.