My experience with the surgical treatment of gastric and duodenal ulcers / [Hans Finsterer].

  • Finsterer, Hans, 1877-1955.
Date:
1950
Catalogue details

Licence: In copyright

Credit: My experience with the surgical treatment of gastric and duodenal ulcers / [Hans Finsterer]. Source: Wellcome Collection.

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    cardiospasm, when I was absent for a surgical meeting. Instead of trying a medical treatment my assistant operated immediately and used for a Witzel fistula a rubber tube which was thick as a thumb. Since by this procedure the jejunum was totally obstructed, the patient vomited for 4 days until I came back and removed the rubber tube. Then the vomiting stopped, the patient could eat everything but lost the food through the jejunal fistula. Extraperitoneal closing of this fistula was of no success and another operation for doing a unilateral or bilateral exclusion of the fistula, which would have been very easy, was refused l>y the relatives and by the patient himself. The patient died after seven weeks from starvation. If an ulcer on the posterior stomach wall is extended as far as the cardia, a curved resection of the ulcer is not possible. In such cases one can do with good immediate and permanent results the Kelling-Madlener operation. With this procedure the distal half of the stomach is re¬ moved and an anastomosis after Billroth I is performed. In cases of a narrow duodenum or a second ulcer in the duodenum, at least 2/3 of the stomach is resected and a Hofmeister-Finsterer anastomosis is per¬ formed. The ulcer which is left in the cardiac part will heal very quickly because the patient becomes anacid. The immediate operative results are satisfactory as in cases in pri¬ vate hospitals I had no deaths. In the ward cases the mortality is rela¬ tively high (75 cases with 4 deaths, or 5.1 per cent), but the deaths were not in direct connection with the type of operation but with the poor condition of the ward patients during and after the war. The permanent results are also satisfactory as Madlener had no failure in 29 cases, and in 27 cases the good results were stated 3 to 16 years after the operation. My private cases have all remained cured from 5 to 20 years. My ward cases were followed up by my assistant. Dr. Winkler, who could state that 25 cases were free from any trouble for 3 to 7 years and two cases have occasional trouble from cardiospasm. Therefore, one can conclude that Madlener’s operation can be ad¬ vised in the rare cases in which a curved resection is not possible and a total gastrectomy, which is proposed by some surgeons, not necessary. The only disadvantage is the possibility that, though there is no more ulcer, yet there may be a degenerated ulcer or primary cancer. In such occasions it is necessary to make a gastrotomy and to examine the stomach with the introduced finger (without rubber glove!) in order to determine