The surgical treatment of peptic ulcer disease. A physician's view

Current opinions concerning the surgical treatment of peptic ulcer disease are reviewed. Because of the differences between duodenal and gastric ulcers the approaches to the surgical treatments of these lesions differ. For duodenal ulcers surgery is seldom required when the ulcer craters do not heal or, more often, when the disease is not adequately controlled. In these cases the preferred treatment is hyperselective vagotomy. However, the relatively high level of recurrence some years after hyperselective vagotomy may lead to more radical surgery in the future. In contrast to duodenal ulcers, the risk of cancer with gastric ulcers, although low and difficult to evaluate, often leads to quicker surgical intervention. For gastric ulcers the surgeon faces the difficult choice between partial gastrectomy and vagotomy with ulcer excision.