[Surgical treatment of ulcers]

Since the introduction of cimetidine the number of patients operated upon for peptic ulcer has decreased in most departments of surgery. This is mainly due to a change in attitude towards the indication for surgery in chronic uncomplicated duodenal ulcer. The classic surgical indications of perforation, hemorrhage, and pyloric obstruction remain unchanged, but the criterion of intractability as an indication for elective surgery needs to be redefined. For chronic recurrent uncomplicated duodenal ulcer in the otherwise fit and healthy subject, prolonged treatment with cimetidine is not a suitable alterative to surgery. Proximal gastric vagotomy is the method of choice for elective operation in chronic duodenal ulcer. In gastric ulcer the situation is complicated by the risk of failure to diagnose malignancy and erroneous conservative treatment of cancer taken for benign ulcer disease. Follow-up by repeated endoscopies and biopsies is a sine qua non for conservative management of gastric ulcer. The results of surgical treatment of gastric ulcer are satisfactory. Postsurgical symptoms and recurrent ulcer are less frequent after resection for gastric ulcer than after operations for duodenal ulcer. Resection is still considered the method of choice. The results of prospective studies do not at present support the treatment of gastric ulcer by vagotomy rather than by gastric resection. Reoperation for postoperative recurrent ulcer carries a higher risk than the primary intervention. On the other hand, recurrent ulcer responds quite favorably to cimetidine treatment. Cimetidine may serve as an initial therapeutic approach to obtain healing of the ulcer and postpone corrective surgery to a later, elective date.