Abstracts
1998 Digestive Disease Week

#969

SURGERY OF GASTRODUODENAL ULCER: EVOLUTION OF SURGICAL RECRUITMENT (1972-1996). O Huber, JM Megevand, R Chautems, P Majno, Ph Morel. Department of Surgery. University Hospital of Geneva. Geneva. Switzerland.

During the last 25 years, we have performed in our Department 1862 operations for gastro-duodenal ulcer (GDU) (964 elective (52%) and 898 emergencies (48%), mean 74 ± 26 per year). During the study period, the respective proportions of elective and emergency cases varied in a very different way. The number of emergency cases (hemorrages and perforations) remained quite stable (mean 36 ± 4,5 / year) during the whole study period, with a constant proportion of hemorrhages and perforations averaging 50% each. Thus, neither the introduction of more and more potent antisecretory drugs nor the possibility to eradicate Helicobacter Pylori (HP) did influence the number of surgical complications of GDU disease. Conversely, the number of cases operated in elective conditions decreased sharply but unevenly. The introduction on the Swiss market of cimetidine in 1978 coincided with the first inflexion of this curve: from 68 ± 12 per year for the period 1972-77, the number fell to 36 ± 4 for the period 1978-91. The appearance of new and more potent antisecretory drugs (particularly omeprazole in 1988) had no visible influence on our numbers. The effect of HP eradication was more difficult to demonstrate, probably because more and more effective therapies were introduced progressively. We observed nevertheless a clear inflexion of the curve in 1992 (36 ± 4 per year for the period 1978-91 to 9 ± 6 for 1992-96). The last period (1994-6) was characterized by a quasi appearance of elective surgery, with 4 operations only performed during these 3 years! These tendencies, based on a great number of cases, were observed in a center which is the only public hospital for the Geneva region: this fact gives a quasi-epidemiological dimension to our results. This «eradication» of elective surgery causes new problems for academic departments for training young surgeons, implying notably a better supervision of emergency surgery.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.