Perforated gastric ulcer--reappraisal of surgical options.
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.


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% (26% for gastrectomy, 19% for ulcer excision and 5% for 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.


CONCLUSIONS
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.
Madiba
T E
TE
Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban.
Nair
R
R
Mulaudzi
T V
TV
Thomson
S R
SR
D000328:Adult; D013505:Digestive System Surgical Procedures; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications* / Q000601:surgery*