The Declining Role of the Surgeon in the Treatment of Acid-Peptic Diseases

Abstract

Operations such as partial gastrectomy or some type of vagotomy at one time appeared prominently in operating room schedules. In recent years, there has been a drastic reduction in the number of such procedures. For example, a 14-hospital Veterans Administration cooperative study to evaluate the efficiency of parietal cell vagotomy in the treatment of duodenal ulceration (DU) had to be cancelled because of insufficient numbers of patients. In the past, the most frequent indication for the surgical treatment of DU was intractability. Currently, the only patients who are being referred for operation are those with complications of severe bleeding, gastric outlet obstruction, and perforation. Several factors may account for this decline. A prominent one has been a fall in the incidence of peptic ulceration both in the United States and in Great Britain.^1,2 Although some of the decline may reflect improved methods of diagnosis, a true decrease is suggested