Complications after elective gastric resection for duodenal ulcer. Multivariate analysis of risk factors

The records of 545 consecutive patients, who underwent elective Billroth II gastric resection for pyloric or duodenal ulcer were examined retrospectively to identify a group of high-risk patients for life threatening postoperative complications or death. Thirty-two preoperative clinical, endoscopic, surgical and haematological variables were analyzed by stepwise logistic regression. Major complications occurred in 39 patients (7%) and eight patients (1.5%) died. The patient characteristics associated with the major complications and death were liver cirrhosis (Odds ratio 6.7 95% Confidence interval 1.3-33.8), white blood cell count > 10,000/mm3 (Odds ratio 5.5 95% Confidence interval 1.7-17.3), previous abdominal surgery (Odds ratio 4.6 95% Confidence interval 1.7-12.1), and ulcer penetrating contiguous structures (Odds ratio 3.3 95% Confidence interval 1.2-8.9). There was no statistically significant interaction between the above risk factors in causing complications or death. It can be concluded that even if only one of these four risk factors is present in patients undergoing elective surgery for duodenal ulcer a riskless technique, such as proximal gastric vagotomy, should be used instead of Billroth II gastric resection.