The albatross syndrome--how to prevent it.

While no single test or historical feature will allow the physician to predict the patients who will have poor results from ulcer surgery, certain factors may alert the physician to a possible poor result and encourage careful re-evaluation of the need for surgery. Any patient with intractable pain should be assessed carefully in an attempt to establish the cause of the intractability, and this assessment should include endoscopy. The endoscopist may help to identify those patients with structural disease that is too minimal to explain the intractable complaints. Careful attention should also be given to the evaluation of the patient's personality, work record, and relationship to spouse, family, and friends. Patients who have previously been disabled by other medical problems such as low back injury should be approached with caution. While newer procedures in ulcer surgery may alter the incidence of standard postgastrectomy complications it will not alter the incidence of the albatross syndrome, which is more directly related to the selection of the patient rather than the selection of the surgeon or surgical procedure.