Currently, the rare elective surgical indications for uncomplicated peptic ulcer are limited to medical treatment failures and suspected malignancy for the gastric ulcer. Hyperselective vagotomy, because of its functional safety and its feasibility by laparoscopy, is currently the surgical treatment of choice for refractory non-stenosing duodenal ulcer. The risk of degeneration requires the resection of any gastric ulcer resistant to medical treatment. Gastrectomy according to Péan gives fewer recurrences than vagotomy-pyloroplasty with excision of the ulcer, but as many as hyperselective vagotomy with excision. Hyperselective vagotomy is only possible for ulcers in the vertical portion of the stomach. Atypical exeresis should be preferred to conventional gastrectomies, the sequelae and morbidity of which are less.
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