Surgical Aspects of Gastric and Duodenal Ulceration

Twenty to thirty years ago many physicians and surgeons found little justification for surgery in dealing with uncomplicated gastric or duodenal ulcer. Since then the tide has changed and it has become apparent that surgery offers more than medicine, at any rate for the really chronic recurrent ulcer. When the merits of medicine and surgery appeared to be equally balanced, not unnaturally, medical treatment remained the chief standby. After all, to decide on an operation, then of high mortality, required a serious and responsible decision by the surgeon and a rather alarming and difficult step by the patient, in a disease the symptoms of which tended to come and go capriciously. Furthermore, to a surgeon, a surgical mortality is usually a shock, attended by depression and heartsearching, whereas the same man will take a more philosophical and detached view of the death of an ulcer patient from an ulcer complication occurring during medical treatment, even though it might have been avoided by timely operative intervention. More recent opinion has turned towards surgery because while medical management is efficient in dealing with relapses as they arise, it has made little progress in the prevention of these relapses, except by enforcing a state of invalidism on the patient. Surgery on the other hand has become steadily safer and more efficient, particularly in the last decade.