[Ulcer disease. The role of the surgeon]

Today the therapeutical approach towards the 'ulcer disease' consists mostly of medical treatment. Surgical intervention has decreased and is commonly used only for the treatment of emergencies, complications and in cases not responding to medical therapy. If surgical intervention is necessary because of recurring disease despite a complete conservative treatment, resection should be preferred for sufficient therapy of the 'ulcer disease'. Many acutely bleeding ulcers can be controlled by endoscopic methods, however, bleeding ulcers with a high rate of recurrence (Forrest Ia and IIa at the dorsal duodenum and at the small curvature of the stomach) should be treated by resection. Especially elderly, multimorbid patients in this situation should be considered for an early elective surgical procedure. Perforating ulcera duodeni can be treated sufficiently by excision and oversewing in most cases, whereas perforated ulcera ventriculi should always be resected because of possible malignant transformation.