The Role of Ulcer Surgery Today

Abstract

Surgical therapy of gastroduodenal ulcers has again reached a turning point. The development of new, more potent drugs such as omeprazol and the discovery of Helicobacter pylori as a possible etiological factor in the pathogenesis of ulcer disease call for a revision of established therapeutic strategies. Today, partial gastric resection has its place in peptic ulcer treatment only in a few selected indications: (a) suspicion of malignancy, (b) recurrent ulcer following, highly selective vagotomy (HSV), refractory to conservative therapy, and (c) comphcated large ulcer. In gastric ulcer the indication for resection should be set rather liberally because a chronic benign ulcer often cannot be distinguished macroscopically from a malignant one, and biopsies can yield false negative results. Even definite healing tendencies under conservative therapy are not reliable criteria for benign status. However, partial gastrectomy should no longer be used electively for duodenal ulcer. It is too dangerous and may produce troublesome side effects such as dumping and bile reñux; long-term sequelae include loss of weight, bone disease, and anemia and increase the chance of eventual death from gastric cancer.