EDITORIAL - IS VAGOTOMY AND GASTRECTOMY STILL JUSTIFIED FOR GASTRODUODENAL ULCER

Definitive treatment of peptic ulcer has traditionally focused on ''acid control,'' including such operations as partial gastrectomy and truncal vagotomy. Whereas these therapies have generally been successful, untoward side effects persist, especially after major operations. The recent discovery that Helicobacter pylori is the prime causative agent of the peptic diathesis and that its eradication from the stomach lining is associated with long-term remission of ulcer disease suggests that current surgical treatment protocols should now be modified accordingly. For treatment of life-threatening complications, such as bleeding, perforation, and obstruction, operation is still mandatory; however, the bleeding artery should simply be ligated, the perforation ''plugged,'' or the obstruction bypassed. For definitive management of the ulcer, short-term treatment with H2 and proton blockers should be promptly instituted. For long-term ''cure,'' H. pylori should be eliminated from the stomach by administration of appropriated antibiotic drugs. Vagotomy and partial gastrectomy and its myriad variations to prevent ulcer recurrence are no longer necessary nor appropriate.