Perforated duodenal ulcer--long-term results following simple closure

Perforated duodenal ulcer was treated with suture plication in 77 patients. Only one-third of the operations were performed within six hours of the onset of perforation symptoms. The postoperative morbidity and mortality were related to the duration of the perforation and the age of the patient. The postoperative mortality rate was 6.5%. Fifty-three of the patients could be followed up after a mean period of 7.5 years. The long-term results were unsatisfactory in 84% of the patients who had had ulcer symptoms for more than three years prior to perforation, but in only 18% of those with symptoms for less than three years. Simple closure thus seems to be the treatment of choice for perforated duodenal ulcer when the patient's general health is poor or when the history of ulcer symptoms is short. A definitive operation, consisting of selective proximal vagotomy with or without drainage, should be considered for good-risk patients with pre-perforation ulcer symptoms for more than three years.