[Postbulbar ulcer. An eclectic surgical approach].

The only possible explanation for the large variability in therapeutic results following surgery for postbulbar ulcer (PBU) may be the main attitude towards the postbulbar lesion. It is always desirable to remove the ulcer, but occasionally this may submit the patient to high risks, unacceptable for a benign condition. Pathogenic operation may be performed, regardless the handling of the ulcer, so only the main ulcer complication may decide the need for ulcer removal. The aim of our retrospective study upon 78 cases operated between 1984-1994 was consistency between actual clinical reality of PBU and surgical attitude. Ulcer penetration was so usual (58/78 cases) that the main indication for surgery was: bleeding (19 patients), total obstruction (18 cases) or blocked perforation (5 cases). Only 11/78 PBU were located on suprapapillary D2. Almost all patients (95%) were submitted to gastric resection +/- vagotomy, but only 27% of them removed the ulcer. The early unsatisfactory results were due to 7.7% fistulous morbidity and 2.6% mortality. Till now there here was no late ulcer recurrence or unsatisfactory results related to ulcer remanence.