IntroductionThe surgical management of peptic ulcer disease (PUD) has undergone profound changes over the past decades due to advances in medical management. Despite this reduced need for surgical intervention in the management of PUD, the absence of standardized, evidence-based guidelines for when gastroduodenal resection is warranted presents a significant gap in the literature. This review seeks to address this deficiency by summarizing the current literature and clarifying the indications for gastrectomy in the management of PUD, offering a framework for consistent and informed surgical decision-making.MethodsWe performed a literature review by searching PubMed, Google Scholar, and the Cochrane Library for studies of human participants, published in English between 2010 and 2024. Keywords utilized included "gastrectomy," "surgical management in PUD," "omental flap," and "vagotomy." The results were summarized with contextual recommendations.ResultsFrom the total of 6250 publications retrieved from the databases, we ultimately included 29 publications following a review of the abstracts and manuscripts. The management of peptic ulcer disease (PUD) has undergone a significant transformation, shifting from predominantly surgical interventions to advanced medical therapies, supported by innovations in pharmacotherapy, nutritional support, and endoscopic techniques.ConclusionSurgery, particularly gastrectomy, remains essential in specific cases such as large or multiple ulcers, ulcers associated with malignancy, and complicated cases that do not respond to other treatments. Emerging technologies continue to refine risk prediction and patient management, offering hope for further reducing surgical interventions. Despite these advancements, timely surgical intervention remains critical for managing life-threatening complications.