Operations for duodenal ulcer disease.

Operative treatment of duodenal ulcer has been restricted to the small proportion of ulcer patients who have complications of ulcers or to those patients who do not respond to medical treatment. The principal surgical procedures that have been used include different types of gastric drainage, gastric resection, gastric denervation, or various combinations of these principles. Initially, the primary objective of ulcer surgery was to prevent recurrent ulcer. Currently, the objectives of operation are to cure an ulcer without a recurrent ulcer or any undesirable sequelae developing as a result of altered gastric physiology. Perhaps no operation will satisfy each of these conditions for every patient. Parietal cell vagotomy without a drainage procedure, the latest contribution to ulcer surgery, has been intensively studied for 19 years. The operative mortality of 0.26%, the recurrence rate of 4 to 11%, and virtually no significant side effects have caused the operation to become the procedure of choice for an increasingly large number of gastric surgeons.