Classic indications and goals for peptic ulcer surgery
Since the introduction of H 2 -receptor antagonists and proton pump inhibitors (PPIs) and the identification of Helicobacter pylori as an ulcerogenic cofactor, the frequency of elective operations for peptic ulcer disease (PUD) has decreased by more than 90%. Currently, surgery for duodenal and gastric ulcers is reserved for the management of complications of PUD, the most common being stricture or perforation (10-35% of patients). The classic indications for peptic ulcer surgery are:
- • Intractability of symptoms
- • Suspicion of malignancy (peptic ulcer failed to heal after 12 weeks, even with negative biopsies)
- • Perforation
- • Bleeding (with two failed endoscopic attempts to control hemorrhage and increased transfusion requirements, > 6 units the first 24 hours or > 3 units per day)
- • Gastric outlet obstruction (GOO)
The main goals of surgery are to:
- • Treat any complications of PUD
- • Eliminate the factors that contribute to ulcer occurrence
