[Analysis of therapeutic failures of three surgical concepts for treatment of duodenal ulcer-results of a prospective consecutive study (author's transl)].

In a prospective study 3 surgical concepts were used to treat patients with chronic duodenal ulcer. In concept I 64 patients were treated with "individual ulcer surgery", i.e. depending on the general condition of the patient, the local intraoperative situation and preoperative acid output, either selective vagotomy with pyloroplasty, with antrectomy (B-I) or B-II gastrectomy were used. In concept II 62 patients were treated with selective vagotomy and pyloroplasty. In concept II 110 patients with highly selective vagotomy and treated without drainage. The conditions were diagnosed and the patients were treated in a standardized manner. Follow-up rates were 90% and above and the results were analyzed according to Troidl's definition of operative failures after 1-year follow-up. Lethality was 0% in all concepts (I-III). Recurrent ulcer: I=0%, II=3%, III=4.5%. Complaints with Visick-classifications III and IV: I=14%, II=12.8%, III=45%. Changing symptoms: I=0%, II=0%, III=1%. No acid reduction: I=0%, II=4.9%, III=l6,4%. The lowest recurrence rate and best acid reduction was concept I, the best overall clinical outcome concept III. Highly selective vagotomy without drainage is preferred as the least major and most careful procedure at the moment.