[Current elective surgery of chronic duodenal ulcers]

At present a number of different procedures are used for elective surgery of chronic duodenal ulcer. The merits and demerits of established methods such as subtotal gastrectomy, truncal vagotomy with drainage and truncal vagotomy with antrectomy are discussed from the viewpoint of operative mortality, recurrence rate and postoperative sequelae. Vagotomy techniques have been refined by the addition of selective vagotomy and proximal gastric vagotomy with and without a drainage procedure. Proximal gastric vagotomy appears to involve fewer side effects than any of the other methods. However, information about longterm recurrence rate after proximal gastric vagotomy is still scant. Methods for checking the completeness of vagotomy are still unsatisfactory. It is still not known whether the operation can or must be "tailored" to the needs of the individual patient according to the results of secretion studies. It is felt that the established procedures still have a place in the surgical treatment of chronic duodenal ulcer. Truncal vagotomy and drainage is a good operation, especially for emergency surgery and in poor risk patients. The longterm results of subtotal gastrectomy are less satisfactory than has been assumed, and it is therefore suggested that this operation should be performed less frequently in the treatment of chronic duodenal ulcer.