[Surgical therapy in the treatment concept of ulcer disease. A critical evaluation]

Since the introduction of H2-receptor antagonists ulcer therapy has changed in favour of conservative management against surgery. In spite of this shift in therapy mortality from peptic ulcer did not decrease through the last three decades. Obviously conservative management does not influence the rate of ulcer complications but postpones them to the aged. Peptic ulcer surgery offers differentiated therapies for complications as well as for uncomplicated ulcer disease. In bleeding ulcers combination of therapeutic endoscopy and early elective surgery reduced mortality to 5%. Targets of therapy are both bleeding and ulcer disease. Obstruction is cured in the same way as uncomplicated ulcers with additional pyloro- or duodenoplasty. In cases of perforation the decision for simple suture or definitive treatment should be orientated to ulcer history. Due to their localisation uncomplicated ulcers are treated best by selective proximal vagotomy, combined resection or Billroth I resection. After surgery the monthly recurrence risk of uncomplicated ulcers is about ten times lower than throughout long-term conservative therapy. From the present point of view only surgery seems to be able to reduce persisting rates of ulcer mortality in the future.