Limited operation for bleeding or perforated gastric ulcer in high risk patients

Twenty-four high risk patients underwent limited operation for bleeding (15) or perforated (9) gastric ulcers. Limited operation is defined as local ulcer management (oversewing or excision of bleeding ulcer and suture closure of perforated ulcer) with (8) or without (16) complementary vagotomy and pyloroplasty. Sixteen patients had serious coexistent disease and eight were physiologically unstable because of continued bleeding or peritonitis. Nine patients (38%) died; seven of 15 (47%) died after operation for bleeding and two of nine (22%) after operation for perforation. Only one patient rebled prior to death, and only two patients died of causes directly attributable to the operative procedure. The remaining six patients died as a result of coexistent disease. Limited operation for gastric ulcer is an option for treatment of highly selected, high risk patients requiring urgent operation for bleeding or perforated ulcer. The addition of complementary vagotomy and pyloroplasty appears to make little difference as to the immediate result but may influence late results. Limited operation does not reduce the mortality rate after operation on patients with bleeding or perforated ulcers.