[Current status of the treatment of perforated duodenal ulcer]

A European study involving 15 major centres shows that the surgical treatment of a perforated duodenal ulcer depends closely upon the underlying condition and the operative risk. The latter is determined on the basis of the age of the subject, the time since the perforation, and the chronicity of the ulcer as well as the possible concomitant existence of severe medical pathology. In the optimal situation, preference is given to suture of the perforation and supraselective vagotomy. When general conditions are poor, the tendency is for a more simple approach such as simple suture or even the Taylor Wangensteen method. Type B II gastric resection remains indicated where there is associated bleeding or in the presence of large non-suturable ulcers which cannot be dealth with by a Rives-type patch of epiploon.