Primary Definitive Surgery in Perforated Peptic Ulcer: Is it Necessary?

Abstract

Aim: Evaluate the role of primary definitive surgery on the treatment of perforated peptic ulcer. Methods: Patients with a perforated peptic ulcer occurring in the period from 1983 until 1993 were studied retrospectively by evaluating inpatient and outpatient records in combination with a general practitioners’ inquiry. Short-term and long-term results were assessed with regard to type of surgical treatment, i.e., simple closure (SC) alone versus highly selective vagotomy (HSV) with SC. Results: Forty out of 81 patients (49%) that were available for long-term follow-up had recurrent ulcer disease (complaints), of which 28 out of 61 of the SC group (46%) and 12 out of 20 of the HSV group (60%). Moreover, in 17 patients treated with SC, but preoperatively judged to need a HSV or meeting the criteria for a HSV, only 7 patients (41%) had recurrent ulcer disease. Conclusion: Primary definitive surgery in perforated peptic ulcer disease has no advantages over SC. Treatment should thus consist of SC of the perforation.