A 35-year-old man presents with a bleeding duodenal ulcer documented by endoscopy. The patient is somewhat unstable, and bleeding does not stop despite transfusing 8 U of blood. What is the most appropriate surgical therapy?

For the patient who is unstable and has a pyloric or duodenal ulcer, oversewing the ulcer and closing the pyloric incision as a pyloroplasty and performing a vagotomy is the procedure of choice because of its low operative mortality. However, this procedure carries a higher-recurrence rate. Major resections, such as antrectomy and subtotal gastrectomy are contraindicated in the unstable patient. At endoscopy biopsies for H. pylori should be taken and, if positive, treatment designed to eradicate H. pylori should be started. Eradication of H. pylori reduces the recurrence rate of bleeding.