Simple closure and follow up H2 receptor antagonists for perforated peptic ulcer--immediate survival and symptomatic...

There is controversy over the optimum treatment of perforated peptic ulcer. Non-operative management is associated with a high incidence of subsequent operation while immediate definitive surgery is associated with a high initial peri-operative mortality. We have a policy of simple closure and follow up H2-receptor antagonists. This study reviews 100 consecutive patients to identify immediate survival and subsequent symptomatic results of this surgical policy. The mean age was 49 years with 24 patients over 70 years. Sixteen were taking H2-receptor antagonists and 20 taking non-steroidal anti-inflammatory drugs on admission. Simple closure was performed in 94 and six had definitive surgery as their first procedure. The 30 day mortality was 6% (1% for < 70 yrs n = 76, 20% for > 70 yrs n = 24). Complete follow up was achieved in 90%, (range 2-80 months). Seventy-four percent were asymptomatic, 13% intermittently symptomatic and 7% had continuous symptoms. Only five patients (6%) required subsequent definitive surgery. The policy of simple closure and follow up H2 receptor antagonists for perforated peptic ulcer is safe and effective in the long term.