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Awaiting moderation 61890 Article

Treatment of ulcers: surgery

        TREATMENT OF ULCERS: SURGERY
Q. Suppose that when everything possible has been tried the patient still does not recover from his ulcer. Or, as we have just mentioned, complications take place. Does surgery hold the final and ultimate answer for these patients?
A. True. About 90 per cent of ulcers are cured by medical treatment and good nursing but about 10 per cent require surgery. The chief reasons which indicate the need for surgery are that the ulcer persists despite thorough and conscientious medical treatment, it may haemorrhage, perforation may have
occurred, there may be an obstruction or there may be signs of
malignancy (cancer) especially in stomach ulcers.
Over the years various forms of surgery have been tried and
these are constantly varying. There is no doubt as to the value of
surgery in difficult cases, especially where there are serious
complications.
Q. What operations are currently performed?
A. An operation called the vagotomy and drainage procedure is used for persisting duodenal ulcers. This cuts the nerve to the acid secreting glands so that further acid production is prohibited.
Q. What about stomach ulcers that don't heal?
A. Another operation called the Bilroth 1 gastrectomy is carried out. This also is very successful, for it removes a large part of the acid producing wall of the stomach.
Q. Does that summarise the current status of peptic ulcers?
A. I think it does. But in concluding this section, let me quote from a leading professor of medicine in Sydney who specialises in ulcers. He recently wrote: 'No patient in any society should be allowed to experience the morbidity, economic and social loss and mortality associated with an unhealed chronic ulcer.' That sums up the situation in the 1980s. I agree with his sentiments entirely and I am sure nearly every Australian doctor will concur.
Q. Now that we have handled in detail this very common problem, why don't we go on to examine some of the other relatively frequent and quite important disorders of other parts of the G.I. system?
A. Yes. I think we should tackle them in order of merit from this point on. Some are extremely important and their early diagnosis and treatment are vital. Others whilst probably annoying are not life endangering.
As we said earlier, this small booklet is not an encyclopaedia, so that the disorders will be mentioned fairly briefly from now on. But it will serve as a guide of what disorders may take place, how they may be recognised, when to see the doctor and a guide to the type of treatment you may be offered. It is designed to be informative and, ideally, supplement the advice of your own physician. It is not meant to replace his care. Treatment is always a very personal matter and is always tailor-made to suit the individual needs of each patient. It is important to remember this.
*22\61\2*
Gastrointestinal


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