1.1. One hundred seventy-one cases of patients having ulcer of the stomach or duodenum operated upon by the method of Billroth 1 or the modification of Billroth 2 (Mikulicz-Kronlein-Reichel) are presented.2.2. Of 113 patients operated upon by the method of Billroth 1, 73 cases were of the stomach (antrum), 23 of the duodenum, and 17 of the pylorus. In those ulcers of the stomach 58 per cent were classified as cured, 11 per cent as greatly improved and 12 per cent as unimproved; the remaining 19 per cent lying between the two latter groups. In the duodenal ulcers, 52 per cent could be classed as cured, 13 per cent as greatly improved, 17 per cent as improved and 17 per cent as unimproved.3.3. The mortality rate in the Billroth 1 operation was 9.1 per cent.4.4. Of 58 patients operated upon by the modified Billroth 2 procedure, 30 cases were of the stomach, 25 of the duodenum, and 3 of the pylorus. In those ulcers of the stomach, 60 per cent were classed as cured, 23 per cent as greatly improved, 7 per cent as improved, and 10 per cent as unimproved. In the duodenal ulcers, 52 per cent were classified as cured, 12 per cent as greatly improved, 24 per cent as improved and 12 per cent as unimproved.5.5. The mortality rate in the modified Billroth 2 operation was 13.8 per cent. Of the 17 deaths 14 were operated on for ulcer of the duodenum.6.6. The results obtained in ulcer of the stomach with the modified Billroth 2 operation were somewhat better than those obtained with the Billroth 1, but in this small series one could in general say that there is little to choose in the end-results of the two methods.7.7. The figures from a small series of gastroenterostomies are given. It is worthy of note that of the 5 deaths in 105 cases 2 were attributable to perforation of the duodenal ulcer on the fifth and fourteenth postoperative day.8.8. Gastroenterostomy with the occlusion of the pylorus after the method of von Eiselsberg has given unhappy results.9.9. The rules followed in this clinic for the selection of the operative method are given.10.10. Ulcers of the duodenum which are strongly adherent to or have penetrated into the pancreas are to be operated upon conservatively.11.11. Billroth 1 and Billroth 2 are to be considered as two entirely different operations, each having its definite indications. They are not to be used interchangeably or the one substituted for the other with the operative procedure well under way.12.12. The results obtained by the general surgeon will only show improvement after he has thoroughly learned to fit the operative procedure to the pathology and to respect ulcers of the duodenum which have become adherent to the pancreas as carrying the highest operative risk.

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HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 001637 | SxmlIndent | more

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