Posterior Gastro-Enterostomy in the Treatment of Peptic Ulceration

Clark, Douglas H (1950) Posterior Gastro-Enterostomy in the Treatment of Peptic Ulceration. Ch.M thesis, University of Glasgow.

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1. The broad trend of Surgical treatment in peptic ulceration is traced. Though the trend has been towards the more radical procedure of extensive gastrectomy several authorities maintain, with variable emphasis, that gastro-enterostomy is still a valuable procedure. 2. Attention has been drawn to the danger in comparing mortality rates where the age distribution of patients is not known. 3. Methods of reporting follow-up results is briefly discussed and the caution required in comparing results is stressed. A method of reporting results which allows of comparison with similarly reported results is used in the present investigation. 4. The material in this review consists of 330 posterior gastro-enterostomies performed for peptic ulceration between the years 1924 and 1937. Of these 270 were traced. 5. The results are given on a cumulative basis over a period of 20 years. The impact of site of ulceration, presence or absence of obstruction, age, sex and chronicity of ulcer on the results is analysed. 6. The curative effect of gastro-enterostomy per se as a treatment/ treatment of peptic ulceration has been estimated and found to he considerable, 7. The general results show that in round figures after a period of between 15 and 20 years, 50% are found to have recurrence of symptoms; 25% being no better or worse, 12.5% slightly improved and 12.5% markedly improved. 50% are symptom free. 8. The pathology of recurrence is discussed and the author is of the opinion that this is largely due to secondary ulceration at the stoma. 9. The danger of perfoiming gastro-enterostomy for gastric ulcer is stressed. 10. The place of gastro-enterostomy in the treatment of peptic ulcer is discussed and the only factors discerned which improve the results have been the presence of organic pyloric stenosis, old age and female sex. The tentative suggestion is made that when the mortality and morbidity rates for gastrectomy in the older age groups is better known, there may be a place for gastro-enterostomy in those age groups. 11. The mechanism by which the operation produces a favourable result is not obvious. Gastric acidity is, on the average, unchanged, high post-operative levels being consistent with good results. The gastric motility is also unchanged.

Item Type: Thesis (Ch.M)
Qualification Level: Masters
Keywords: Medicine
Date of Award: 1950
Depositing User: Enlighten Team
Unique ID: glathesis:1950-79787
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 03 Mar 2020 10:36
Last Modified: 03 Mar 2020 10:36

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