Surgical treatment of duodenal ulcer.

This paper reviews the pathophysiology of peptic ulcer disease, the role of the vagus and gastrin in the control of gastric acid secretion and motility and the rationale for modern operations for peptic ulcer. The importance of arriving at a balanced decision before recommending surgery for a peptic ulcer is discussed. The indications for surgery in elective and emergency cases are defined and the results reviewed critically and compared with medical treatment. Novel operative procedures are mentioned but still await validation follow-up studies before their final assessment. Well tried operations should not be dismissed lightly and the importance of prospective randomized trials to evaluate new procedures is emphasized.