Antrectomy for Peptic Ulcers: Historical Role & Modern Therapy

Antrectomy (resection of gastric antrum) was once a primary ulcer surgery. **It is now obsolete for uncomplicated peptic ulcer disease.**

Historical Context

• Antrum produces gastrin → stimulates acid. Removing it reduced acid.
• Combined with vagotomy (truncal, selective, highly selective) to prevent gastric stasis.
• High morbidity: Dumping syndrome, bile reflux, weight loss, diarrhea, malnutrition.

Modern Paradigm Shift

• H. pylori discovery (1982): 90% duodenal, 70% gastric ulcers caused by *H. pylori*.
• Eradication therapy (PPI + 2 antibiotics × 14 days): Cures ulcer, prevents recurrence. **First-line for all H. pylori+ ulcers.**
• PPIs (omeprazole, pantoprazole): Potent acid suppression; heal ulcers, maintain remission.
• NSAID-induced ulcers: Stop NSAID if possible; co-prescribe PPI; test/treat H. pylori.

Current Surgical Indications (Rare)

• Perforation not amenable to simple closure.
• Obstruction (pyloric stenosis) unresponsive to medical therapy.
• Refractory bleeding despite endoscopic/angiographic control.
• Gastric cancer (antrectomy as part of gastrectomy).

Procedures Today

• Laparoscopic patch repair (perforation).
• Highly selective vagotomy (rare) + drainage.
• Pyloroplasty / gastrojejunostomy for obstruction.

Antrectomy is a historical footnote. H. pylori eradication + PPIs have made elective ulcer surgery nearly extinct.