Stomal and recurrent ulceration: Medical or surgical management?

During the past 15 years we have treated 175 patients with stomal or recurrent ulcers, approximately half of whom had undergone primary surgery elsewhere. Medical treatment with cimetidine was no more effective than placebo in a controlled trial involving 24 patients. Forty-three patients have been treated with cimetidine, and healing was achieved in 24 (56 percent). Of these 43 patients, 17 (40 percent) have already undergone operation.One hundred fifty patients have been treated surgically with no primary mortality. In 142 patients an acid-reducing procedure was used. With vagotomy or revagotomy alone, there were 6 further recurrences among 38 patients (16 percent). With gastric resection alone, there were two recurrences among 33 patients (6 percent), whereas there was only one recurrence among 71 patients with revagotomy and antrectomy (1.4 percent). Of the nine patients with rerecurrences, eight needed further operation; two of these patients died after emergency reoperation for hemorrhage. There is little difference between the results of Billroth I and Billroth II antrectomy, but if the latter is used the addition of a Roux loop should be considered.