[Surgery of gastroduodenal ulcers in the Czech Republic]

Evaluation of surgical treatment of gastroduodenal ulcers during the past 20 years and its importance at the present time.

During the past 20 years three questionnaire surveys were implemented in surgical departments in the Czechoslovak Republic (1975-57 departments, 1989-80 departments) and in the Czech Republic (1994-80 departments) focused on surgery of gastroduodenal ulcers. The authors analysed also a group of patients from their own department covering a five-year period (1990-89 operations and 1995-27 operations).

In surgical departments of the Czechoslovak and Czech Republic the ratios of different operations during the mentioned years were as follows: 1975: resections 85%, vagotomy 9%, suture of perforation 6%. 1989: 71%, 10%, 19% and 1995: 48%, 8%, 31% and other operations 13%. In the authors department the ratio of these operations in 1990 was as follows: 23%, 23%, 10% and in 1995: 59%, 7%, 23%, 11%. The surgical approach declined in the course of five years by 70%. During the last two years in the Czech Republic and in the authors department first experience was assembled with laparoscopic suture of perforated ulcers and with superselective vagotomy. The initial results are very encouraging.

The basis of treatment of gastroduodenal ulcers is modern medicamentous treatment, surgery is indicated most frequently if conservative treatment fails or in case of haemorrhage (78% of haemorrhages are controlled endoscopically). In gastric ulcers resection is indicated most frequently, similarly as in complications of duodenal ulcers. In non-complicated duodenal ulcers superselective vagotomy is an equivalent alternative of long-term conservative treatment.