Thanks to advances in ulcer treatment, surgery for ulcers is seldom necessary outside of an emergency situation. Ulcer Treatment: Why Surgery Is Rare “Surgery used to be performed fairly routinely to take out the part of the stomach that makes acid,” says Patrick I. Okolo, III, MD, MPH, chief of endoscopy at Johns Hopkins Hospital and assistant professor of gastroenterology and hepatology at Johns Hopkins University School of Medicine in Baltimore. “However, proton pump inhibitors are so effective that we can achieve the same results with these medications alone and avoid surgery. Surgery is reserved only for people who are unable to take the drug, those the drug has not worked in, and those who have suffered a major complication.” Examples are if the ulcer caused an obstruction in the stomach or duodenum that is preventing proper digestion or if it perforated, or went through, the stomach wall. Ulcer Treatment: Why Surgery Is Needed “Surgery is very rare now,” says James McGuigan, MD, professor of medicine in the division of gastroenterology, hepatology, and nutrition at the University of Florida College of Medicine in Gainesville. However, Dr. McGuigan details those situations when surgery may be needed to correct the problem:

Perforated ulcer. If an ulcer continues to grow so that it creates a hole in the stomach or intestinal wall, it is called a perforated ulcer. Surgery for a perforated ulcer typically involves the surgeon sewing up the hole, explains McGuigan.Bleeding ulcer. Doctors will try to stop the bleeding using a laser during an endoscopy. Endoscopy is a procedure that involves threading an endoscope, flexible tube with a light, camera, and tiny instruments attached to it, through your mouth into your stomach while you are sedated. If the laser isn’t effective at controlling the bleeding, a procedure called a partial gastrectomy could be performed to remove part of the stomach, says McGuigan.Uncontrolled stomach acid. Sometimes ulcers do not heal despite treatment and your and your doctor’s best efforts. In the rare event that medications do not control your stomach acid, which can make it difficult for ulcers to heal, then surgical options for acid management include:Partial gastrectomy. In order to control acid levels, doctors take out part of the stomach that stimulates acid release to keep your acid levels down.Vagotomy. In this procedure, the surgeon selectively cuts the vagus nerves or its smaller branches, which stimulate acid production.Pyloroplasty. According to McGuigan, vagotomy was once often performed in combination with a pyloroplasty, surgery that widens the base of the stomach. This procedure, as well as others, can be done for obstructed gastric emptying due to ulcer scarring or inflammation.

Fortunately, advances in ulcer medication have made surgery for ulcers rare. The key is seeing your doctor as soon as you feel discomfort so that your ulcer can be treated in its earliest stages and you can begin your recovery.