Current status of indications for surgery in peptic ulcer disease

The eradication of Helicobacter pylori in patients with peptic ulcer diseas e has greatly diminished the need for antiulcer surgery. However, in societ ies where such drug therapy is considered too expensive and because occasio nal patients remain refractory to optimal medical therapy, elective surgery for duodenal ulcer disease is still carried out, If the required expertise is available, it can be undertaken laparoscopically. The advent of endosco pic therapies such as heater probe therapy and injection sclerotherapy has also greatly diminished the need for emergency surgery in bleeding peptic u lcer disease. Once again, however, when such therapy fails surgery is still indicated. El en with perforated peptic ulcer disease the role of surgery has receded somewhat, but here not because of changes in drug therapy. Nono perative management of perforation is indicated in fit patients if the diag nosis is in doubt, in any patient when surgical facilities are unavailable (e.g., remote geographic areas, on board ship), or when a patient is extrem ely ill either because of comorbidity or late presentation of the disease. Operation should be considered in all patients when the perforation is esta blished to be unsealed, particularly after a trial of conservative manageme nt, and in all patients who are otherwise fit.