Definitive or conservative surgery for perforated gastric ulcer?--An unresolved problem.
BACKGROUND
Gastric ulcer perforation has not been the focus of many studies. In addition there is a need to analyze the results of gastric perforation separately and not along with duodenal perforations, to identify the factors influencing the outcome and to develop strategies for its management.


METHODS
Retrospective analysis of 54 patients presenting with gastric perforation.


RESULTS
Mean age of the patients was 44.5 years with male preponderance. Morbidity following Closure of the perforation, acid reduction surgery and resection was not significantly different. Overall mortality was 16.6% with highest mortality 24.1% following simple closure. Mortality following simple closure and definitive surgery was not significantly different. Univariate analysis revealed preoperative shock, associated medical illness and surgical delay to be significant factors for mortality whereas on multivariate analysis, preoperative shock was the only independent predictor of mortality. Mortality increased with increasing Boey score but the association between the type of surgery and probability of survival was not statistically significant.


CONCLUSIONS
Boey risk score is useful in predicting the outcome of surgical treatment for gastric perforation. Definitive surgery is not associated with greater morbidity or mortality compared to simple closure.
Sarath Chandra
Sistla
S
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. sarathsistla@hotmail.com
Kumar
S Siva
SS
D000328:Adult; D000368:Aged; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000401:mortality / Q000601:surgery*; D055815:Young Adult