The Result of Surgical Treatment of Complicated Peptic Ulcers: Analysis of Factors Affecting the Morbidity Rate

ABSTRACT

BACKGROUNDS The aim of this retrospective study was to compare patients treated for complicated peptic ulcers with special reference to the morbidity and the mortality rates and its determining factors according to the type of surgery. METHODS: From Jan. 1988 to May 1996, a total of 168 patients with complicated peptic ulcers underwent surgical treatment. Among them, 39 patients were lost during the follow up period and 10 cases were operated on due to pyloric obstruction, so we analyzed 119 cases according to the type of surgery (definitive or minimal). Definitive surgery means acid-decreasing procedures such as a gastrectomy or a truncal vagotomy with drainage procedure. Minimal surgery means life-saving procedures such as primary closure or bleeding vessel ligation. The type of operation was determined according to the preference of the individual consultant surgeons at our institute. RESULTS: There were 70 definitive and 49 minimal operations (64). The mean follow-up period was 20.6 months (range 11-73 months). The risk factors affecting the morbidity and the mortality were comparable for both groups. In spite of little statistical significance, the results of definitive surgery were superior to those of minimal surgery in morbidity (15.7%20.4%), mortality (0%6.1%), recurrence (5.5%12.2%), and Visick grading scale 1 & 2 (92.8%81.6%). The determining factor affecting morbidity was the presence of combined disease (p=0.001) only; other factors such as age, anemia, leukocytosis, presence of preoperative shock, transfusion amount, and type of operation did not affect the morbidity rate. CONCLUSION: Considering that there were no differences in postoperative morbidity and mortality between definitive and minimal surgery, it is better to perform definitive surgery on patients who have no serious combined disease.