Which Operation for Perforated Duodenal Ulcer?

Abstract

Patients with perforated duodenal ulcers were randomly assigned to treatment by one of two teams depending on the day of their admission. Team 1 favoured treatment by definitive ulcer curing surgery (usually truncal vagotomy and pyloroplasty) and 79% of patients were treated in this way. Team 2 favoured conservative surgery (oversewing) and only 36% of patients treated by this team had a definitive procedure (p < 0.001). The overall mortality rate for patients treated by the two teams was the same (18.3%). Bearing in mind the high recurrence rates which have been reported after simple oversewing we would recommend that definitive surgery is preferable for most cases of duodenal perforation.