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Marginal ulcer. A difficult surgical problem

B D Schirmer, W C Meyers, J B Hanks

    Annals of Surgery
    |May 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

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    Recurrent ulcer surgery outcomes vary by initial procedure. Non-acid-reducing operations had higher recurrence rates, while gastroenterostomy offered longer symptom-free intervals. Marginal ulcer diagnosis sensitivity differed between endoscopy and upper GI series.

    Area of Science:

    • Gastroenterology
    • Surgical Outcomes Research

    Background:

    • Recurrent ulcers after surgery pose a significant clinical challenge.
    • Understanding factors influencing recurrence and treatment outcomes is crucial for patient management.

    Purpose of the Study:

    • To evaluate the outcomes of surgical treatment for recurrent or marginal ulcers.
    • To analyze factors affecting recurrence rates and symptom-free intervals following initial ulcer operations.

    Main Methods:

    • Retrospective analysis of 166 patients with recurrent/marginal ulcers (excluding gastrinoma) from 1950-1980.
    • Evaluation of initial operation types, symptom-free intervals, diagnostic methods (endoscopy, upper GI series), and surgical re-treatment outcomes.
    • Assessment of recurrence rates, mortality, morbidity, and overall patient satisfaction post-treatment.

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    Main Results:

    • Non-acid-reducing operations were associated with the highest recurrence rates.
    • Gastroenterostomy demonstrated a significantly longer symptom-free interval compared to other procedures.
    • Endoscopy (85% sensitivity) was more sensitive than upper GI series (71%) for diagnosing marginal ulcers.
    • Surgical treatment for second marginal ulcers had a 20.4% recurrence rate, 2.3% mortality, and 10.6% morbidity.
    • Re-operation for recurrent ulcers resulted in a 29.2% recurrence rate with 12.5% morbidity.
    • Overall, 58.2% of patients achieved satisfactory to excellent outcomes, while 42.8% had unsatisfactory results.

    Conclusions:

    • Initial surgical approach significantly impacts recurrent ulcer rates.
    • Diagnostic accuracy varies between endoscopic and imaging techniques.
    • While surgical re-intervention can be performed with low mortality, recurrence remains a considerable concern, highlighting the need for optimized primary surgical strategies.