Retrospective Study on Various Surgical Approaches for Gastric Ulcer Perforation. A Comparative Study

Gastric ulcer perforation remains a life-threatening emergency requiring timely surgical intervention. Multiple operative techniques exist, including primary closure, modified Graham's patch repair, gastrojejunostomy, and use of falciform ligament in cases of omental deficiency.

A retrospective analysis was conducted from January 2020 to December 2024 involving 120 patients diagnosed with gastric ulcer perforation. The study included patients treated at both SRVS Medical College and a local private hospital. Based on intraoperative findings and surgeon preference, patients underwent one of the following surgical techniques: Group A (n = 40)-primary closure; Group B (n = 35)-modified Graham's patch repair; Group C (n = 25)-gastrojejunostomy for giant perforations; Group D (n = 20)-falciform ligament patch in cases with deficient greater omentum.

Group A showed shorter operative time (mean 55 ± 10 min) and hospital stay (mean 6 ± 2 days), but had a 15% rate of minor leakage. Group B had a leakage rate of 8.5%, with slightly longer operative time (mean 70 ± 12 min). Group C, used in giant perforations (>2 cm), had the longest operative time (mean 95 ± 15 min) but the lowest leak rate (4%), albeit with a prolonged hospital stay (mean 10 ± 3 days). Group D showed moderate outcomes with a 10% complication rate and hospital stay of 8 ± 2 days. Mortality was highest in Group A (2 cases), likely due to delayed presentation and peritonitis.

Modified Graham's patch repair and gastrojejunostomy offer better outcomes in terms of leakage prevention and postoperative recovery compared to primary closure. The falciform ligament serves as a viable alternative in cases of omental deficiency.