[Long-term study of gastroduodenal ulcer perforation]

One hundred forty-four patients, peptic (129 males and 15 females) treated for peptic ulcer perforation between 1972 and 1988 were reviewed. All were treated surgically, and in 28 the ulcer was also treated. The mean perforation time before treatment was 14 +/- 12.3 hours. The immediate postoperative results and long-term evolution were evaluated on the basis of the medical history, follow-up check-ups and home questionnaires. The were post-operative complications in 33 (23%) of the 137 patients who survived surgery; there was no difference in morbidity between the group in which only Closure and Epiploplasty (group C + E) were performed and group CD, where some type of definitive surgery was added, although the seven deaths belonged to the former. Of the 104 patients who were evaluated on a long-term basis (follow-up period of 55 +/- 44 months), poor results were obtained in 58 of the 82 belonging to group C + E and in four of the 28 in group CD, with a total of 13 re-operations (12 and one, respectively). Only a previous ulcer history dating from over three months had any effect on the appearance of recurrences in group C + E. We recommend performing a VGP within the first six hours as the preferred technique for pyloric or juxtapyloric perforations in patients with a previous ulcer history exceeding three months, since the rate of cure is satisfactory and there are few if any complications.