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Twenty-five years after Billroth II gastrectomy for duodenal ulcer

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Abstract

One thousand twenty-five patients underwent a Billroth II resection for duodenal ulcer between 1948 and 1956. The operative mortality rate was 2.4%. At follow-up between 22 and 30 years later, 522 had died and 423 patients were traced. Recurrent ulcer appeared in 2.6% of the cases. Postgastrectomy symptoms occurred with the following frequency: dumping 10%, diarrhea 5%, vomiting 7%, and pain 4%. Anemia developed in 18%, hypoalbuminemia and hypocalcemia in 40 and 15%, respectively. Eleven percent had lost more than 10 kg in weight. Tuberculosis was found in 3% of the cases. While 90% of the patients were satisfied with the result, 10% were failures. The overall mortality rate was significantly increased because of suicide. Gastric carcinoma was the cause of death no more often than expected.

Résumé

De 1948 à 1956, 1 025 malades atteints d'ulcère duodénal ont subi une opération de Billroth II. La mortalité a été de 2,4%. Au cours de l'évolution de 22 à 30 ans après l'intervention, 522 opérés sont décédés et 423 ont été suivis. La fréquence de la récidive a été de 2,6%. Les symptômes après gastrectomie ont atteint les taux suivants: dumping 10%, diarrhée 5%, vomissements 7%, douleur 4%. L'anémie a été constatée dans 18% des cas, l'hypoalbuminémie dans 40% des cas et l'hypocalcémie dans 15% des cas, onze pour cent des opérés ont accusé une chute pondérale supérieure à 10 kg; 3% ont présenté une tuberculose. Au total 90% des malades se sont déclarés satisfaits de l'intervention, encore que certains opérés se soient suicidés, ce nombre intervenant dans la mortalité globale. La mortalité par cancer n'a pas dépassé le taux accusé par la population en général.

Resumen

En años anteriores la gastrectomía Billroth II fue un procedimiento operatorio de uso común en el tratamiento de la úlcera duodenal. Los promisorios resultados de la vagotomía con drenaje, vagotomía y antrectomía y, especialmente, la vagotomía de células parietales han reducido el rol de la resección de tipo Bilroth II. El propósito del presente estudio es describir los resultados a largo plazo en un grupo de pacientes sometidos a gastrectomía Billroth II por úlcera duodenal aproximadamente 25 años antes.

Entre 1948 y 1956, 1 025 pacientes consecutivos, 810 hombres y 190 mujeres, fueron sometidos a resección Billroth II por úlcera duodenal. La mortalidad operatoria fué de 2,4%. Durante el período de seguimiento entre 22 y 30 años, 522 pacientes habían muerto y 423 pacientes pudieron ser ubicados para seguimiento. Síntomas de post-gastrectomía fueron observados con la incidencia siguiente: “dumping” 10%, diarrea 5%, vómito 7% y dolor 4%. La anemia se presentó en el 18%, hipoalbuminemia e hipocalcemia en el 40% y en el 15% respectivamente. Se presentó tuberculosis en el 3% de los casos. El 90% de los pacientes se mostraron satisfechos con el resultado de la operación, pero el 10% restante indicó la falla del tratamiento. La mortalidad global resultó significativamente incrementada debido a una alta incidencia de suicidio. El carcinoma gástrico fue causa de muerte con una frecuencia no aumentada, o sea que no se encontró un mayor riesgo de muerte por carcinoma de esófago o del remanente gástrico.

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References

  1. Jensen, H.-E., Amdrup, E.: Follow-up of 100 patients five to eight years after parietal cell vagotomy. World J. Surg.2:525, 1978

    Google Scholar 

  2. Græm, N., Fischer, A.B., Hastrup, N., Povlsen, C.O.: Mucosal changes of the Billroth II resected stomach. Acta Pathol. Microbiol. Scand. [Sect. A]89:227, 1981

    Google Scholar 

  3. Fischer, A.B., Græm, N., Jensen, O.M.: Risk of gastric cancer after Billroth II resection for duodenal ulcer. Br. J. Surg.70:552, 1983

    Google Scholar 

  4. Fischer, A.B., Knop, J., Græm, N.: Late mortality following Billroth II resection for duodenal ulcer. (in press)

  5. Siegel, S.: Non-parameter Statistics for Behavioral Sciences. New York, McGraw-Hill, 1956

    Google Scholar 

  6. Fischer, A.B., Græm, N., Christiansen, L.A.: Causes and clinical signifiance of gastritis following Billroth II resection for duodenal ulcer. Br. J. Surg.70:322, 1983

    Google Scholar 

  7. Knop, J., Fischer, A.B.: Duodenal ulcer, suicide, psychopathology and alcoholism. Acta Psychiat. Scand.63:346, 1981

    Google Scholar 

  8. St. John, F.B., Harvey, H.D., Gius, J.A., Goodman, E.N.: A study of the results of surgical treatment of peptic ulcer. Ann. Surg.109:193, 1939

    Google Scholar 

  9. Rienhoff, W.F., Jr.: An analysis of the results of the surgical treatment of 260 consecutive cases of chronic peptic ulcer of the duodenum. Ann. Surg.121:583, 1945

    Google Scholar 

  10. Strauss, A.A., Strauss, S.F., Schwartz, A.H., Kram, D.D., Masur, W.W.: Results of subtotal gastrectomy for gastric and duodenal ulcers since 1917. J.A.M.A.149:1095, 1952

    Google Scholar 

  11. Thompson, J.E., Stewart, C.F.: Gastrectomy for peptic ulcer. Ann. Surg.139:721, 1954.

    Google Scholar 

  12. Goligher, J.C., Moir, P.J., Wrigley, J.H.: The Billroth I and Polya operations for duodenal ulcer. A comparison. Lancet1:220, 1956

    Google Scholar 

  13. Jones, C.T., Williams, J.A., Cox, E.V., Meynell, M.J., Cooke, W.T., Stammers, F.A.R.: Peptic ulceration. Some haematological and metabolic consequences of gastric surgery. Lancet1:425, 1962

    Google Scholar 

  14. Krause, U.: Iron deficiency and anaemia following partial gastrectomy. Ups. J. Med. Sci.67:290, 1962

    Google Scholar 

  15. Wall, A.J., Ungar, B., Baird, C.W., Langford, I.M., Mackay, J.R.: Malnutrition after partial gastrectomy. Influence of site of ulcer and type of anastomosis and role of gastritis. Am. J. Dig. Dis.12:1077, 1967

    Google Scholar 

  16. Krause, U.: Late prognosis after partial gastrectomy for ulcer. A follow-up study of 361 patients operated upon from 1905 to 1933. Acta Chir. Scand.114:341, 1957

    Google Scholar 

  17. Kemp, D.: An evaluation and comparison of the early and late results of standardized Polya gastrectomy. Gut8:151, 1967

    Google Scholar 

  18. McKeown, K.C.: A prospective study of the immediate and long-term results of Polya gastrectomy for duodenal ulcer. Br. J. Surg.59:849, 1972

    Google Scholar 

  19. Dinbar, A., Avigad, I., Shafir, R., Tulcinsky, D.B.: Long-term results of subtotal gastrectomy for duodenal ulcer. World J. Surg.4:625, 1980

    Google Scholar 

  20. Tovey, F.I., Clark, C.G.: Anaemia after partial gastrectomy: A neglected curable condition. Lancet1:956, 1980

    Google Scholar 

  21. Moore, F.D., Peete, W.P.J., Richardson, J.E., Erskine, J.M., Brooks, J.R., Rogers, H.: The effect of definitive surgery on duodenal ulcer disease. A comparative study of surgical and non-surgical management in 997 cases. Ann. Surg.132:652, 1950

    Google Scholar 

  22. Brookes, V.S., Waterhouse, J.A.H., Thorn, P.A.: Partial gastrectomy for peptic ulcer. Gut1:149, 1960

    Google Scholar 

  23. Postlethwait, R.W.: Retrospective study of operations for peptic ulcer. Surg. Gynecol. Obstet.149:703, 1979

    Google Scholar 

  24. Christiansen, J., Jensen, H.-E., Ejby-Poulsen, P., Bardram, L., Henriksen, F.W.: Prospective controlled vagotomy trial for duodenal ulcer. Primary results, sequelae, acid secretion, and recurrence rates two to five years after operation. Ann. Surg.193:49, 1981

    Google Scholar 

  25. Wallensten, S.: Results of the surgical treatment of peptic ulcer by partial gastrectomy according to Billroth I and II method. Acta Chir. Scand. [Suppl.]191:1, 1954

    Google Scholar 

  26. Ochsner, A., Zehnder, P.R., Trammell, S.W.: The surgical treatment of peptic ulcer: A critical analysis of results from subtotal gastrectomy and from vagotomy plus partial gastrectomy. Surgery67:1017, 1970

    Google Scholar 

  27. Clark, C.G., Logie, N.J.: Partial gastrectomy for duodenal ulcer. J.R. Coll. Surg. Edinb.7:209, 1962

    Google Scholar 

  28. Rhea, W.G., Jr., Killen, D.A., Scott, H.W.: Long-term results of partial gastric resection without vagotomy in duodenal ulcer disease. Surg. Gynecol. Obstet.120:970, 1965

    Google Scholar 

  29. Welch, C.: Subtotal gastrectomy for duodenal ulcer. Surg. Clin. North Am.46:339, 1966

    Google Scholar 

  30. Postlethwait, R.W., Dillon, M.L.: Gastric resection for duodenal ulcer. Surgery69:829, 1971

    Google Scholar 

  31. Wells, C., MacPhee, I.W.: Partial gastrectomy: Ten years later. Br. Med. J.13:1128, 1954

    Google Scholar 

  32. Small, W.P.: The long-term results of peptic ulcer surgery. Clin. Gastroenterol.2:427, 1973

    Google Scholar 

  33. Amdrup, E.: The dumping syndrome and other postcibal symptoms following partial gastrectomy. Thesis, University of Copenhagen, 1960

  34. Amdrup, E.: Postgastrectomy syndromes. Am. J. Dig. Dis.11:432, 1966

    Google Scholar 

  35. Schirmer, J.F., Bowers, W.F.: Observations based on two hundred forty-five consecutive gastrectomies for duodenal ulcer disease at Brooke Army Hospital. Arch. Surg.74:447, 1957

    Google Scholar 

  36. Ellison, E.H.: Research groups spring meeting. Gastroenterology33:912, 1957

    Google Scholar 

  37. Amdrup, E.: Invited commentary on “Long-term results of subtotal gastrectomy for duodenal ulcer.” World J. Surg.4:625, 1980

    Google Scholar 

  38. Gollgher, J.C., Riley, T.R.: Incidence and mechanism of the early dumping syndrome after gastrectomy. Lancet1:630, 1952

    Google Scholar 

  39. Pulvertaft, C.N.: The late results of gastric resection. Br. J. Surg.61:414, 1964

    Google Scholar 

  40. Nyhus, L.M.: Invited commentary on “Review of elective surgical treatment of chronic duodenal ulcer.” World J. Surg.1:9, 1977

    Google Scholar 

  41. Meurling, S.: Postcibal symptoms after partial gastrectomy for peptic ulcer. Thesis. Acta Soc. Med. Uppsala [Suppl.]3:1, 1953

    Google Scholar 

  42. Amdrup, E.: Variations in food tolerance after partial gastrectomy. Acta Chir. Scand.120:410, 1961

    Google Scholar 

  43. Skarstein, A.: Partial gastrectomy for peptic ulcer by Krönlein method. Scand. J. Gastroenterol.15[Suppl. 64]:1, 1980

    Google Scholar 

  44. Amdrup, E.: Hvorledes undgår vi ventrikelresektionsfølger? Svensk kirurgisk Forenings årsskrift, 1976, pp. 125–139

  45. Baird, I.M., Wilson, G.M.: The pathogenesis of anaemia after partial gastrectomy. II. Iron absorption after partial gastrectomy. Q. J. Med. [N. S. 28]109:35, 1959

    Google Scholar 

  46. Krause, U.: Long-term results of medical and surgical treatment of peptic ulcer. A follow-up investigation of patients initially treated conservatively between 1925–34. Monograph. Acta Chir. Scand. [Suppl]310:1, 1963

    Google Scholar 

  47. Wheldon, E.J., Venables, C.W., Johnston, I.D.A.: Late metabolic sequelae of vagotomy and gastroenterostomy. Lancet1:437, 1970

    Google Scholar 

  48. Shafer, R.B., Ripley, D., Swain, W.R., Mahmud, K., Doscherholmen, A.: Hematologic alterations following partial gastrectomy. Am. J. Med. Sci.266:240, 1973

    Google Scholar 

  49. Mahmud, K., Ripley, D., Swaim, W.R., Doscherholmen, A.: Hematologic complications of partial gastrectomy. Ann. Surg.127:432, 1973

    Google Scholar 

  50. Mahmud, K., Kaplan, M.E., Ripley, D., Swaim, W.R., Doscherholmen, A.: The importance of red cell B12 and folate levels after partial gastrectomy. Am. J. Clin. Nutr.27:51, 1974

    Google Scholar 

  51. Deller, D.J., Witts, L.J.: Changes in the blood after partial gastrectomy with special reference to vitamin B12. I. Serum vitamin B12, haemoglobin, serum iron and bone marrow. Q. J. Med.31:71, 1962

    Google Scholar 

  52. Roos, D.: Neurological complications in patients with impaired vitamin B12 absorption following partial gastrectomy. Monograph. Acta. Neur. Scand. [Suppl.]69:1, 1978

    Google Scholar 

  53. Brookes, V.S., Maynell, M.J., and Bold, A.M., Kingston, R.D.: A review of symptoms, haematology and clinical chemistry following a partial gastrectomy. Br. J. Surg.61:9, 1974

    Google Scholar 

  54. Buxton, R.A., Collins, C.D., Phillips, M.J.: Vitamin B12 deficiency following Polya gastrectomy. A long-term follow-up. Br. J. Clin. Pract.31:69, 1977

    Google Scholar 

  55. Rygvold, O.: Hypovitaminosis B12 following partial gastrectomy by the Billroth II method. Scand. J. Gastroenterol.9[Suppl. 29]:57, 1974

    Google Scholar 

  56. Schrumpf, A., Gjertsen, K.: Serum B12 and serum iron after gastric surgery. Acta Med. Scand.186:561, 1969

    Google Scholar 

  57. Zollinger, R.M., Ellison, E.H.: Nutrition after gastric operations. J.A.M.A.154:811, 1954

    Google Scholar 

  58. Eddy, R.L.: Metabolic bone disease after gastrectomy. Am. J. Med.50:442, 1971

    Google Scholar 

  59. Fukuda, M., Shibata, H., Hatakeyama, K., Yamagishi, Y., Soga, J., Koyama, S., Muto, T.: Difference in calcium metabolism following Billroth I and Billroth II procedures for gastric and duodenal ulcers. Jpn. J. Surg.9:295, 1979

    Google Scholar 

  60. Wastell, C.: Malabsorptive states after gastrointestinal surgery. Br. Med. J.3:661, 1968

    Google Scholar 

  61. MacLean, L.D., Perry, J.F., Kelly, W.D., Mosser, D.G., Mannick, A., Wangensteen, O.H.: Nutrition following subtotal gastrectomy of four types (Billroth I and II, segmental, and tubular resections). Surgery35:507, 1954

    Google Scholar 

  62. Hillman, H.S.: Postgastrectomy malnutrition. Gut9:576, 1968

    Google Scholar 

  63. Silen, W.: Consequences of gastric resection and vagotomy. Mayo Clin. Proc.48:653, 1973

    Google Scholar 

  64. Booth, C.C., Brain, M.C., JeeJeebhoy, K.N.: Hypoproteinaemia after partial gastrectomy. Proc. R. Soc. Med.57:582, 1964

    Google Scholar 

  65. Morgan, D.B., Paterson, C.R., Woods, C.G., Pulvertaft, C.N., Fourman, P.: Search for osteomalacia in 1228 patients after gastrectomy and other operations on the stomach. Lancet2:1085, 1965

    Google Scholar 

  66. Duthie, H.L.: Partial gastrectomy for peptic ulcer: Six years after. Scot. Med. J.5:127, 1960

    Google Scholar 

  67. Johnston, I.D.A., Welbourn, R., Acheson, K.: Gastrectomy and loss of weight. Lancet1:1242, 1958

    Google Scholar 

  68. Din, N.A., Small, W.P.: Death after partial gastrectomy for peptic ulcer—a long-term study. Gut15:335, 1974

    Google Scholar 

  69. Ross, A.H.M., Smith, M.A., Anderson, J.R., Small, W.P.: Late mortality after surgery for peptic ulcer. N. Engl. J. Med.307:519, 1982

    Google Scholar 

  70. Eriksson, S.B.S.: The operated stomach. Bulletin no. 36 from Department of Surgery, University of Lund, Sweden, 1983

    Google Scholar 

  71. Westlund, K.: Mortality of peptic ulcer patients. Acta Med. Scand. [Suppl.]402:1, 1963

    Google Scholar 

  72. Viskum, K.: Ulcer, attempted suicide and suicide. Acta Psychiat. Scand.51:221, 1975

    Google Scholar 

  73. Robins, E., Murphy, G.E., Wilkinson, R.H., Jr., Gassner, S., Kayes, J.: Some clinical considerations in the prevention of suicide based on a study of 134 successful suiciders. Am. J. Publ. Health49:888, 1959

    Google Scholar 

  74. Pokorny, A.D.: Suicide rates in various psychiatric disorders. J. Nerv. Ment. Dis.139:499, 1964

    Google Scholar 

  75. Barraclough, B.M., Bunch, J., Nelson, B.: A hundred cases of suicide. Clinical aspects. Br. J. Psychiat.125:355, 1974

    Google Scholar 

  76. Hagnell, O., Rorsman, B.: Suicide in the Lundby study: A comparative investigation of clinical aspects. Neuropsychobiology5:61, 1979

    Google Scholar 

  77. Beskow, J.: Suicide and mental disorders in Swedish men. Acta Psychiat. Scand. [Suppl.]277:1, 1979

    Google Scholar 

  78. Goodwin, D.W.: Alcohol in suicide and homicide. Q. J. Stud. Alcohol.34:144, 1973

    Google Scholar 

  79. Stalsberg, H., Taksal, S.: Stomach cancer following gastric surgery for benign conditions. Lancet2:1175, 1971

    Google Scholar 

  80. Helsingen, N., Hillestad, L.: Cancer development in the gastric stump after partial gastrectomy for ulcer. Ann. Surg.143:173, 1956

    Google Scholar 

  81. Stalsberg, H.: Carcinoma of the oesophagus of gastric surgery. Lancet1:381, 1972

    Google Scholar 

  82. Domellöf, L., Janunger, K.-G.: The risk for gastric carcinoma after partial gastrectomy. Am. J. Surg.134:581, 1977

    Google Scholar 

  83. Clark, C.G., Ward, M.W.N., McDonald, A.M., Tovey, F.I.: The incidence of gastric stump cancer. World J. Surg.7:236, 1983

    Google Scholar 

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  1. Surgical Department I, Kommunehospitalet, Copenhagen, Denmark

    Anders B. Fischer M.D.

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Supported by grants from the Danish Medical Research Council (No. 512-8760) and “Købmand i Odense Johann & Hanne Weimann, født Seedorffs legat.”

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Fischer, A.B. Twenty-five years after Billroth II gastrectomy for duodenal ulcer. World J. Surg. 8, 293–301 (1984). https://doi.org/10.1007/BF01655056

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