GREATER discretion is exercised today in the surgical treatment of peptic ulcer than at any former time. Rarely is surgical treatment employed before an adequate trial on an intelligent medical regimen has failed. Definitive therapeutic operations are fewer than in 1930 and are accomplished with low mortality and morbidity. Today, three operations are employed almost exclusively in the surgical treatment of peptic ulcer. They are gastric resection, gastroenterostomy and vagotomy. They are not new procedures. Each has been credited with successes, complications and failures that have been duly recorded in the medical literature over the past 50 years.
Twenty years ago the major American clinics appeared convinced that gastroenterostomy was the procedure of choice. A large number of papers from these clinics reported apparent success with this procedure in 80 to 85 per cent of the patients on whom it was used. Its operative mortality rate was low, much lower