Abstract
Surgical treatment of peptic ulcer disease: current indications and techniques
Highlights
The need for surgery has dramatically decreased in the last recent years, some indications still persist
There are some indications for elective surgery such as refractory ulcers and cases of uncertain diagnosis
Many cases of refractory ulcers or uncertain diagnosis and gastric outlet obstruction unsuccessfully treated by endoscopy need elective surgery
Summary
The need for surgery has dramatically decreased in the last recent years, some indications still persist. Endoscopic treatment decreases rebleeding rates, the need of operation and reduces the mortality rate of the patients with bleeding peptic ulcers. Hunt and McIntyre [40] compare patients undergoing operation for bleeding duodenal ulcer They found no difference in mortality but the rates of rebleeding were lower in the resected groups than in the groups treated only with oversewing, even with associated vagotomy 37. Our group found in a prospective study with 92 patients having had perforated peptic ulcer, that simple closure followed by Hpy eradication is associated with a low rate of recurrence and no re-perforation in case of duodenal, pyloric, or pre-pyloric perforated ulcers, this is not acceptable for perforated gastric ulcers [49]. In the cases where the perforation clearly is located in a tumoral area, the options are emergency gastrectomy –doubtfully oncologic- or simple closure and to perform oncologic gastrectomy at a later stage [45]
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