[Type of surgery and mortality rate in perforated duodenal ulcer]

The aim of this study was to evaluate postoperative mortality in patients with perforated duodenal ulcer and concomitant peritonitis. In our department from 1962 to 1999 there were 625 patients operated on for that reason. The most common surgery performed was the "definitive" one, i.e. truncal vagotomy with pyloroplasty. Partial gastric resection was performed infrequent, and gastrectomy was done only exceptionally. Only in elderly with comorbid conditions (concomitant diseases or highly advanced purulent peritonitis) or in very young patients without prior history of ulcer disease, the perforation was sewed or closed by pyloroplasty (118 patients, 18.9%). Overall postoperative morbidity was 11.2% (70 patients died shortly after the surgery). Morbidity among patients in vagotomy and pyloroplasty group was 2.9%, in resection group--3.3% and among these with the perforation just sewed--45.8%. Two patients younger than 50 years died in postoperative course (0.57%). In patients between 50 and 69 years 29 deaths were observed (15.18%). There were 84 patients older than 70 years, and after the surgery 39 of them died (46.43%). It is important to notice, that even that in the oldest patients in 63 cases the perforation was just sewed (the less invasive procedure), 34 of them died. Vagotomy combined with pyloroplasty is valuable and safe procedure which is widely used in perforated duodenal ulcer. Postoperative morbidity is the highest among older patients, regardless of the procedure applied.