[A retrospective survey study of diagnosis and surgical treatment in peptic ulcer]

A total of 239 patients of which 183 operated over the period 1987 through 1992 are reviewed. Cases with duodenal location of the lesion predominate (84 per cent), next ranking gastric ulcers (14 per cent), and type II according to Johnson (2 per cent). Among the patients operated on resection methods, type Billroth II, with antecolic gastroenteroanastomosis and Braun's anastomosis, accounting for 84.1 per cent of the total of planned operations, are mainly used. Retrocolic gastroenteroanastomosis type Hoffmeister-Finsterer is performed in five, and Billroth I-in one patient. Three patients presenting gastric ulcer, free of malignization signs, are subjected to pylorus-preserving resection according to MacKee. Resection methods as a definitive therapeutic approach to ulcers, at that according to Billroth II, are predominant owing to the fact that most patients operated on present ulcers penetrating the pancreas, involving ligamentum hepatoduodenale and the descending portion of the duodenum, and pyloric stenosis, making impossible the restoration of passage by Billroth I or other operations. A lasting good result is attained in 92 per cent of cases, minor complaints are recorded in 6 per cent, and substantial complaints-in 2 per cent. The study results lead to the inference that standard resections with anterior gastroenteroanastomosis in complicated ulcers, ruling out other alternatives, yield a permanent therapeutic effect. The approach to individual patients should be by no means unified, and the most expedient operative procedure should be used. Owing to delayed operative treatment and numerous complications, the classical resection methods prove to be the method of choice in the surgical management of ulcers.