BACKGROUBD: Secondary peptic ulcer surgery is uncommon given the success of a wide variety of medical therapies, plus the good outcome expected after primary peptic ulcer surgery. Early reports of secondary peptic ulcer surgery in the 1950's and 1960's suggested a good long-term outcome in a majority of patients. However, recent reviewers have suggested a worsening outcome in these patients. We have attempted to quantify the poor outcome with these patients and measure the effect of gender, a previously unrecognized risk factor for poor outcome after secondary peptic ulcer surgery.
METHODS: We reviewed the outcomes of 35 patients who underwent secondary peptic ulcer surgery for symptoms of persistent or recurrent peptic ulcer symptoms or complications of the condition. These patients were compared to a "control" group of patients on the following parameters: gender, immediate outcome (morbidity and mortality), long term quality of life as measured by the SF-36 and Visick scores (average follow-up 60 months). Visick and SF-36 scores answers were obtained through telephone interviews. The two groups of patients were age-matched to eliminate age as a variable in the SF-36 results.
RESULTS: There were more females than males in both the secondary and primary groups but the ratio of female/male was significantly higher in the group of patients undergoing secondary peptic ulcer surgery (4.5/1 secondary peptic ulcer surgery vs. 1.7/ primary surgery). Although perioperative mortality was zero for both groups, secondary peptic ulcer surgery patients suffered more complications than primary surgery patients (57% vs. 31%, p= 0.06). Secondary peptic ulcer surgery patients scored poorer in 7 of the eight subclasses of the SF-36 than age matched cohorts. In contrast, average Visick grades slightly improved in 3 out of 4 symptoms reported. Immediate postoperative complications were not related to long term quality of life issues.
CONCLUSIONS: Secondary peptic ulcer surgery is more prevalent in females than in males. While secondary peptic ulcer surgery is partially effective in alleviating symptoms, quality of life is poor.