Surgical Management of Gastric Ulcer

Whether a given gastric ulcer is benign or malignant can be decided only by the pathologist examining the excised specimen. In a series of 155 patients hospitalized with the diagnosis of gastric ulcer, agreement between physician and surgeon that the ulcer was benign occurred in about 7% of the cases. In 5% of the patients the ulceration is believed to have been precipitated by gastric irritants and stimulants, such as medicaments taken habitually. Medical management, including withdrawal of such irritants, should be tried; if this fails a surgical program adapted to the location of the lesion is recommended. The postoperative course of patients with conservative forms of gastric resection was compared with that of patients after radical resections. In a series of 76 patients those with conservative resections were underweight in 42% and troubled with moderate or severe dumping symptoms in 2.6% of the cases, while the corresponding figures for radical resections were 80% and 47%. Routine radical resection for gastric ulcer is not justified by the known incidence of malignancy. Hope lies in better diagnosis and in earlier, rather than more radical, surgery.