Perforated gastric ulcer - reappraisal of surgical options

ABSTRACT

Background: The available operative procedures for perforated gastric ulcer are gastrectomy; ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution.Patients and methods: Seventy-two patients (mean age 43 years; 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. Results: Partial gastrectomy was performed in 27 patients; ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18(26for gastrectomy; 19for ulcer excision and 5for patch closure). Shock on admission (p=0.006) and Candida (p=0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. Conclusion: Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases