EDITORIAL - IS VAGOTOMY AND GASTRECTOMY STILL JUSTIFIED FOR GASTRODUODENAL ULCER

Definitive treatment of peptic ulcer has traditionally focused on ''ac id control,'' including such operations as partial gastrectomy and tru ncal vagotomy. Whereas these therapies have generally been successful, untoward side effects persist, especially after major operations. The recent discovery that Helicobacter pylori is the prime causative agen t of the peptic diathesis and that its eradication from the stomach li ning is associated with long-term remission of ulcer disease suggests that current surgical treatment protocols should now be modified accor dingly. For treatment of life-threatening complications, such as bleed ing, perforation, and obstruction, operation is still mandatory; howev er, the bleeding artery should simply be ligated, the perforation ''pl ugged,'' or the obstruction bypassed. For definitive management of the ulcer, short-term treatment with H2 and proton blockers should be pro mptly instituted. For long-term ''cure,'' H. pylori should be eliminat ed from the stomach by administration of appropriated antibiotic drugs . Vagotomy and partial gastrectomy and its myriad variations to preven t ulcer recurrence are no longer necessary nor appropriate.