Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 May;195(5):653–661. doi: 10.1097/00000658-198205000-00015

Marginal ulcer. A difficult surgical problem.

B D Schirmer, W C Meyers, J B Hanks, W J Kortz, R S Jones, R W Postlethwait
PMCID: PMC1352579  PMID: 7073362

Abstract

One hundred sixty-six patients with documented recurrent or marginal ulcers following previous ulcer operations were seen at Duke Medical Center and the Durham VA Hospital from 1950 through 1980. Patients with the diagnosis of gastrinoma were excluded from the series. Evaluation of initial operation for recurrent ulcer showed that the highest recurrence rate occurred following non-acid-reducing operations. Analysis of the symptom-free interval following initial ulcer operation showed a significantly longer interval prior to recurrent ulcer development following gastroenterostomy than other procedures, while resection and Billroth I reanastomosis showed a significantly shorter symptom-free interval than did other procedures. Endoscopy proved 85% sensitive in making the diagnosis of marginal ulcer, while upper GI series was 71% sensitive. Surgical treatment of 132 patients resulted in a 20.4% recurrence rate of second marginal ulcer, with a 2.3% mortality rate and a 10.6% morbidity rate. Second operation for recurrent ulcer in 24 patients yielded no deaths, a 12.5% morbidity rate, and a 29.2% recurrence rate. Average follow-up for the series was 12.3 years, and ultimate outcome of treatment showed, of patients not lost to follow-up, a 58.2% satisfactory to excellent rating, while 42.8% of patients had an unsatisfactory result of treatment.

Full text

PDF
653

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BEAL J. M. The surgical treatment of marginal ulcer. Am Surg. 1959 Jan;25(1):1–7. [PubMed] [Google Scholar]
  2. Cleator I. G., Holubitsky I. B., Harrison R. C. Anastomotic ulceration. Ann Surg. 1974 Mar;179(3):339–351. doi: 10.1097/00000658-197403000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Condon J. R., Tanner N. C. Retrospective review of 208 proved cases of anastomotic ulcer. Gut. 1968 Aug;9(4):438–441. doi: 10.1136/gut.9.4.438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. EVERSON T. C., ALLEN M. J. Gastrojejunal ulceration. AMA Arch Surg. 1954 Aug;69(2):140–147. doi: 10.1001/archsurg.1954.01270020006002. [DOI] [PubMed] [Google Scholar]
  5. Fawcett A. N., Johnston D., Duthie H. L. Revagotomy for recurrent ulcer after vagotomy and drainage for duodenal ulcer. Br J Surg. 1969 Feb;56(2):111–116. doi: 10.1002/bjs.1800560208. [DOI] [PubMed] [Google Scholar]
  6. Goligher J. C., Feather D. B., Hall R., Hall R. A., Hopton D., Kenny T. E., Latchmore A. J., Matheson T., Shoesmith J. H., Smiddy F. G. Several standard elective operations for duodenal ulcer: ten to 16 year clinical results. Ann Surg. 1979 Jan;189(1):18–24. doi: 10.1097/00000658-197901000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Jaffe B. M., Newton W. T., Judd D. R., Ballinger W. F., 2nd Surgical management of recurrent peptic ulcers. Am J Surg. 1969 Feb;117(2):214–221. doi: 10.1016/0002-9610(69)90306-7. [DOI] [PubMed] [Google Scholar]
  8. Jordan P. H., Jr, Condon R. E. A prospective evaluation of vagotomy-pyloroplasty and vagotomy-antrectomy for treatment of duodenal ulcer. Ann Surg. 1970 Oct;172(4):547–563. doi: 10.1097/00000658-197010000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lindenauer S. M., Dent T. L. Management of the recurrent ulcer. Arch Surg. 1975 May;110(5):531–536. doi: 10.1001/archsurg.1975.01360110077014. [DOI] [PubMed] [Google Scholar]
  10. MARSHALL S. F., MARKEE R. K. Gastrojejunal ulcer. Am Surg. 1954 Mar;20(3):248–249. [PubMed] [Google Scholar]
  11. MARSHALL S. F., TERRELL G. K. Postoperative recurrent ulcer. Surg Clin North Am. 1957 Jun;37(3):653–663. doi: 10.1016/s0039-6109(16)35186-6. [DOI] [PubMed] [Google Scholar]
  12. Ochsner A., Zehnder P. R., Trammell S. W. The surgical treatment ofeptiulcer: a critical analysis of results from subtotal gastrectomy d frovagotomy plus partial gastrectomy. Surgery. 1970 Jun;67(6):1017–1028. [PubMed] [Google Scholar]
  13. Postlethwait R. W. Five year follow-up results of operations for duodenal ulcer. Surg Gynecol Obstet. 1973 Sep;137(3):387–392. [PubMed] [Google Scholar]
  14. Postlethwait R. W. Retrospective study of operations for peptic ulcer. Surg Gynecol Obstet. 1979 Nov;149(5):703–708. [PubMed] [Google Scholar]
  15. Proot L., Derom F., Van Bastelaere W. Transthoracic vagotomy for recurrent peptic ulcer after gastrectomy. An appraisal of fifteen years experience. Acta Chir Belg. 1978 Sep-Oct;77(5):351–354. [PubMed] [Google Scholar]
  16. Rossi R. L., Braasch J. W. Parietal cell vagotomy. Surg Clin North Am. 1980 Apr;60(2):247–263. doi: 10.1016/s0039-6109(16)42079-7. [DOI] [PubMed] [Google Scholar]
  17. Small W. P., Smith A. N., Ruckley C. V., Falconer C. W., Sircus W., McManus J. P., Bruce J. The continuing problem of jejunal ulcer. Am J Surg. 1971 May;121(5):541–547. doi: 10.1016/0002-9610(71)90135-8. [DOI] [PubMed] [Google Scholar]
  18. Stabile B. E., Passaro E., Jr Recurrent peptic ulcer. Gastroenterology. 1976 Jan;70(1):124–135. [PubMed] [Google Scholar]
  19. Stage J. G., Henriksen F. W., Kehlet H. Cimetidine treatment of recurrent ulcer. Scand J Gastroenterol. 1979;14(8):977–979. [PubMed] [Google Scholar]
  20. Steinberg D. M., Green G., Toye D. K., Alexander-Williams J. The accuracy of methods of diagnosis in patients with suspected recurrent ulcer after vagotomy. Aust N Z J Surg. 1975 Aug;45(3):252–256. doi: 10.1111/j.1445-2197.1975.tb05201.x. [DOI] [PubMed] [Google Scholar]
  21. Thompson J. E., Dailey T. H. Recurrent ulceration after operation for peptic ulcer: results after gastroenterostomy, gastrectomy and vagotomy in 64 cases. Ann Surg. 1966 May;163(5):704–712. doi: 10.1097/00000658-196605000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. WALTERS W., CHANCE D. P., BERKSON J. A comparison of vagotomy and gastric resection for gastrojejunal ulceration: a follow-up study of 301 cases. Surg Gynecol Obstet. 1955 Jan;100(1):1–10. [PubMed] [Google Scholar]
  23. Wychulis A. R., Priestley J. T., Foulk W. T. A study of 360 patients with gastrojejunal ulceration. Surg Gynecol Obstet. 1966 Jan;122(1):89–99. [PubMed] [Google Scholar]
  24. YOUNG G. A., MOVIUS H. J., 2nd Surgical treatment of gastro-jejunal stomal ulcer. Am J Surg. 1962 Aug;104:231–237. doi: 10.1016/0002-9610(62)90323-9. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES