How is surgical tx of duodenal ulcers?

Since the advent of highly effective medical therapy, elective surgery for PUD is quite rare. Surgery is indicated when ulcer is refractory to 12 weeks of medical treatment or hemorrhage, obstruction, perforation. Surgical options: Truncal vagotomy with pyloroplasty Truncal vagotomy with antrectomy + Billroth I gastroduodenostomy or a Billroth II loop gastrojejunostomy. Highly selective vagotomy Truncal vagotomy and selective vagotomy : not commonly performed anymore due to associated morbidity (high rate of dumping syndrome) despite good protection against recurrence. Procedure of choice is highly selective vagotomy (parietal cell vagotomy, proximal gastric vagotomy).