[Surgery of gastric and duodenal ulcer]

The variety of surgical techniques to deal with gastric and duodenal ulcers has been increased by non-resecting methods (truncular, selective, selective proximal vagotomy with or without pyloroplasty). Selective proximal vagotomy has proved its worth in uncomplicated chronic duodenal ulcer. Additional drainage is needed when there is pyloric stenosis. In 309 patients of the surgical department of Cologne-Lindenthal in the years 1970 to June 1975 selective proximal vagotomy for chronic duodenal ulcer had an operative mortality of 0.7%. 1-5 years later 88% of patients had no recurrence. The main cause of recurrence is incomplete vagotomy which could be avoided by the routine intra-operative use of the electrostimulator of Burge. In chronic gastric ulcer removal of the ulcer is needed because of the danger of malignant degreneration. Two third resection is the standard technique. In patients at risk vagotomy, pyloroplasty and excision of the ulcer are indicated.