[Potential for developments in ulcer surgery].

Abstract

Historically, surgery for peptic ulcer has seen the evolution of differing operative principles: resection, vagotomy (truncal, selective, highly selective), and a combination of vagotomy and resection (antrectomy). The long-term effects of the various operations can now be evaluated from several published studies. Though vagotomy and antrectomy is the most "efficient" operation (ulcer recurrence rate 1%), it has the highest morbidity (15-20%) and mortality (1.5-2%); while highly selective vagotomy is the least "efficient" operation (ulcer recurrence rate 10%), it has the lowest morbidity (5%) and mortality (less than 0.5%). In the future, reduced recurrence rates should be possible by improving surgical technique and by better selection of the operative procedure (on the basis of a better selection of the operative procedure (on the basis of a better understanding of ulcer pathogenesis), but without sacrificing the advantages of highly selective vagotomy--low morbidity and mortality--for the majority of patients. Intraoperative testing of the completeness of vagotomy, and addition of a drainage such as pyloroplasty or antrectomy for juxtapyloric ulcers, may help to achieve this goal.