J.Jpn. Surg. Soc.. 79(9): 1063-1068, 1978

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Report on the annual meeting

RESULTS OF SURGICAL TREATMENT FOR GASTRIC AND DUODENAL ULCER

During the past fifteen years (1963-1977), a total of 611 patients with gastric, duodenal or gastroduodenal ulcer (GU, DU, GDU) was operated on in our clinic, which comprised 361 cases with GU, 168 cases with DU and 82 cases with GDU. The operations performed included subtotal gastrectomy in 437, selective vagotomy with antrectomy (SV + A) in 78, selective proximal vagotomy with or without pyloroplasty (SPV±PP) in 74 and miscellaneous procedures in 20. SV + A and SPV + PP were done mainly for patients with DU or GDU.
There were 6 operative deaths (1.4 per cent) in subtotal gastrectomy group and 1 death (5 per cent) in miscellaneous group. However, preoperative condition of these patients was critically ill because of older age, associated disease and complication of massive hemorrhage or perforation, and emergency operation was performed in 6 out of 7. No operative death was observed in SV + A and SPV + PP groups.
Long-term results of the three major operative procedures mentioned above were studied on 436 patients who had passed more than one year after surgery. Ulcer reccurrence was observed in 4 out of 305 cases (1.3 per cent) in subtotal gastrectomy group and in 4 out of 64 cases (4.7 per cent) in SPV ± PP group. However, no significant difference was elicited between these figures of reccurrence rate in two groups. No reccurrence occurred after SV + A. The overall results were evaluated on the basis of Visick grading. Excellent (Grade I) and good (Grade II) results occurred in 87.1 per cent of subtotal gastrectomy group, 85.1 per cent of SV + A group and 84.3 per cent of SPV ± PP group. The difference between the results of any two procedures was not statistically significant.
In conclusion, the apparently good result was obtained neither by SV + A nor by SPV ± PP, compared to those of subtotal gastrectomy. Controlled study in large series should be tried to demonstrate the theoretical superiority of conservative procedures in peptic ulcer surgery.

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