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Perforated gastric ulcers. A plea for management by simple closures
W W Turner1, W M Thompson, E R Thal
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas.
Archives of Surgery (Chicago, Ill. : 1960)
|August 1, 1988
Summary
Simple closure of perforated gastric ulcers using omental patches or excision offers low mortality. Primary gastric resection is reserved for large ulcers, carrying a higher mortality risk.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Medicine
Background:
- Perforated gastric ulcers present a significant surgical challenge.
- Treatment options range from simple closure to radical resection, each with distinct outcomes.
Purpose of the Study:
- To compare the efficacy and safety of different surgical methods for perforated gastric ulcers.
- To identify optimal treatment strategies based on ulcer characteristics and patient outcomes.
Main Methods:
- Retrospective analysis of 107 patients with perforated gastric ulcers.
- Surgical interventions included simple closures (omental patch, primary suture, excision) and primary gastric resection.
- Outcomes assessed included mortality and morbidity (gastric outlet obstruction).
Main Results:
- Mortality rates: 12% for omental patches/excision, 45% for gastric resection, and 62% for suture-only closure.
- Gastric outlet obstruction occurred in 15% of simple closures for prepyloric ulcers.
- Omental patch closure demonstrated a significantly lower mortality than suture-only closure.
Conclusions:
- Simple closure with omental patches or ulcer excision is a safe and effective treatment for perforated gastric ulcers, associated with low mortality and morbidity.
- Primary gastric resection should be reserved for large or prepyloric ulcers where simple closure is not feasible.
- Suture-only closure is associated with a high mortality rate and should be avoided.