[Therapeutic possibilities in therapy-resistant ulcers--surgical aspects]

Indications for surgery and choice of procedure in complicated or chronic gastroduodenal ulcer refractory to conservative treatment are presented. Operations in emergency states are undisputed although they carry a tenfold higher mortality rate than elective procedures. Therefore in spite of effective pharmacotherapy groups at risk have to be identified by interdisciplinary therapeutic concepts in order to enable elective operation on time. Next to patient and ulcer data the efficacy of various procedures has to be considered. The standardized operative techniques and their associated respective rates of complications and recurrence are compared with those of pharmacotherapy.