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Delayed ulcer recurrence after gastric resection: a new postgastrectomy syndrome?
W Browder1, J Thompson, G Youngberg
1Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, USA.
The American Surgeon
|December 11, 1997
Summary
Late recurrent peptic ulcers after gastrectomy, often over 10 years post-surgery, present with obstruction and bezoars. Roux-en-Y reconstruction may be linked to poorer outcomes in H. pylori-positive patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Medicine
Background:
- Recurrent ulceration post-gastrectomy typically occurs early.
- This study focuses on late recurrences (>10 years) after peptic ulcer disease surgery.
Purpose of the Study:
- To analyze clinical characteristics, management, and outcomes of late recurrent ulcers post-gastrectomy.
- To identify factors associated with poor outcomes in this patient cohort.
Main Methods:
- Retrospective review of 20 patients with late recurrent ulcers post-gastrectomy since 1990.
- Evaluation of presenting symptoms, endoscopic findings, Helicobacter pylori status, and surgical re-interventions.
- Analysis of outcomes based on reconstruction type (Roux-en-Y vs. Bilroth II with or without Braun enteroenterostomy).
Main Results:
- Mean age at recurrence was 64 years, with an average of 21 years post-gastrectomy.
- Common symptoms included gastric outlet obstruction (70%) and bezoar formation (60%).
- Eighty percent of patients achieved good to excellent clinical results; however, 4 patients had poor outcomes, associated with H. pylori positivity, preoperative bezoars, and Roux-en-Y reconstruction.
Conclusions:
- Late recurrent ulcers post-gastrectomy present unique challenges, often with obstruction and bezoars.
- Helicobacter pylori positivity, bezoars, and Roux-en-Y reconstruction may predict poorer outcomes.
- Current management favors Braun enteroenterostomy over Roux-en-Y in select cases, warranting further investigation for a potential new postgastrectomy syndrome.