[Is there to be a renaissance of surgical treatment of ulcers?]

Medical treatment of peptic ulcer disease with H2-blockers has over the last ten years practically replaced surgical treatment of this condition, due to greater patient compliance, high effectivity and negligible side-effects. The treatment is, however, strained by the relatively high cost of medication. Development of techniques for laparoscopic vagotomy, which is associated with a considerably reduced postoperative morbidity and reconvalescence as well as entailing only one to two days hospitalization and a minimal surgical scar, has re-opened the debate on medical versus surgical treatment of ulcers. On the basis of a literature review of risk of ulcer recurrence, risk of ulcer complications, cost and compliance associated with the two types of treatment, it is concluded that surgical treatment of peptic ulcers by laparoscopic parietal cell vagotomy should have a renaissance as regards the treatment of patients, who have frequent recurrences when maintained on ordinary medical treatment. However, the development of new, alternative principles for the cheap, effective and complication-free medical treatment of these patients, for example via elimination of helicobacter pylori infection, will necessitate a re-evaluation as regards the treatment of choice.