caa a22 4500 475791185 CHVBK 20180406123711.0 cr unu---uuuuu 170329e20000301xx s 000 0 eng 10.1007/s004230050250 doi (NATIONALLICENCE)springer-10.1007/s004230050250 Surgical management of peptic ulcer disease today - indication, technique and outcome [Elektronische Daten] [T. T. Zittel, E. C. Jehle, H. D. Becker] Abstract : Aims: The current surgical management of peptic ulcer disease and its outcome have been reviewed. Results: Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation, a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in the large majority of cases, and definitive ulcer surgery to reduce gastric acid secretion is no longer justified in these patients. Laparoscopic surgery for perforated peptic ulcer has failed to prove to be a significant advantage over open surgery. In bleeding peptic ulcers, definitive hemostasis can be achieved by endoscopic treatment in more than 90% of cases. In 1-2% of cases, immediate emergency surgery is necessary. Some ulcers have a high risk of re-bleeding, and early elective surgery might be advisable. Surgical bleeding control can be achieved by direct suture and extraluminal ligation of the gastroduodenal artery or by gastric resection. Benign gastric outlet obstruction can be controlled by endoscopic balloon dilatation in 70% of cases, but gastrojejunostomy or gastric resection are necessary in about 30% of cases. Conclusions: Elective surgery for peptic ulcer disease has been largely abandoned, and bleeding or obstructing ulcers can be managed safely by endoscopic treatment in most cases. However, surgeons will continue to encounter patients with peptic ulcer disease for emergency surgery. Currently, laparoscopic surgery has no proven advantage in peptic ulcer surgery. Springer-Verlag Berlin Heidelberg, 2000 Key words Peptic ulcer disease nationallicence Perforation nationallicence Bleeding nationallicence Obstruction nationallicence Laparoscopic surgery nationallicence Zittel T. T. University Hospital, Department of General and Transplantation Surgery, Tübingen University, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany e-mail: TilZittel@aol.com Tel.: +49-7071-2986611 Fax: +49-7071-295500, DE aut Jehle E. C. University Hospital, Department of General and Transplantation Surgery, Tübingen University, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany e-mail: TilZittel@aol.com Tel.: +49-7071-2986611 Fax: +49-7071-295500, DE aut Becker H. D. University Hospital, Department of General and Transplantation Surgery, Tübingen University, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany e-mail: TilZittel@aol.com Tel.: +49-7071-2986611 Fax: +49-7071-295500, DE aut https://doi.org/10.1007/s004230050250 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004230050250 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Zittel T. T. University Hospital, Department of General and Transplantation Surgery, Tübingen University, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany e-mail: TilZittel@aol.com Tel.: +49-7071-2986611 Fax: +49-7071-295500, DE aut NATIONALLICENCE 700 1- Jehle E. C. University Hospital, Department of General and Transplantation Surgery, Tübingen University, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany e-mail: TilZittel@aol.com Tel.: +49-7071-2986611 Fax: +49-7071-295500, DE aut NATIONALLICENCE 700 1- Becker H. D. University Hospital, Department of General and Transplantation Surgery, Tübingen University, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany e-mail: TilZittel@aol.com Tel.: +49-7071-2986611 Fax: +49-7071-295500, DE aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer