BACKGROUND: Unlike colon surgery, gastric surgery developed only slowly. Standardized stomach surgery can be said to have begun in 1881 with Billroth's successful gastric resection. The Department of Surgery in Graz was involved in the development and then rapid dissemination of gastric surgery, with respect to both ulcer and cancer surgery. Since the introduction of the modern proton-pump inhibitors, surgery for gastric ulcers today is mainly limited to the treatment of complications. In spite of the worldwide decrease in the incidence of stomach cancer, it is still of great clinical importance in Austria. METHODS: The development of gastric surgery at the Department of Surgery in Graz is presented on the basis of the literature. RESULTS: Still today, the only curative option for stomach cancer is radical surgical removal with lymphadenectomy as indicated. In the period of January 1, 1994 to December 31, 2004, 341 patients with stomach cancer were treated at the Division of General Surgery in Graz; 265 of them could be operated and the average 5-year survival rate was 36% without regard to tumor stage. CONCLUSIONS: It may be said that more than one hundred years of development have led to the standardization and optimization of gastric surgery, and that the contributions of surgeons in Austria and in Graz were considerable.