Surgical treatment of recurrent peptic ulcer disease

One hundred twenty patients in whom recurrent peptic ulcer developed after various surgical procedures for primary duodenal ulcer were operated on at the Mayo Clinic between 1970 and 1975. The postoperative mortality rate was 3.3% for all cases, 0.9% for elective cases, and 23% for the 13 patients who required emergency surgical care. The mean hospital stay was 13 days, and postoperative complications developed in 25 patients (20%). Approximately 70% of the patients had excellent or good results, whereas the rest had significant postoperative sequelae, including 8.4% (9 patients) in whom rerecurrent ulceration developed. When remedial surgery for recurrent ulcer consisted of vagotomy and distal subtotal gastrectomy (35 patients) after previous vagotomy and drainage procedure (21 patients), subtotal gastrectomy (three patients), vagotomy and hemigastrectomy (eight patients), or gastroenterostomy alone (three patients), there were no operative deaths, 74% of 27 patients available for at least a 5-year follow-up had excellent or good results, and rerecurrent ulceration developed in only one patient. These results indicate that vagotomy and resection is a satisfactory operation for recurrent peptic ulcer and that the long-term results after this operation compare favorably with those reported for cimetidine therapy.