Perforated duodenal ulcer: which operation?

Between January 1968 and December 1977 a total of 230 patients with a perforated duodenal ulcer underwent emergency operation in the Royal Victoria Hospital. Simple suture closure of the perforation was carried out in 205, and in the remaining 25 a definitive ulcer procedure was performed in addition. Four patients died following operation, a mortality rate of 1.7%. During a mean follow-up period of 10.3 years at least 107 patients (52%) who had simple suture closure of their perforation developed further ulcer symptoms. Of these, seven re-perforated and a further 56 required elective definitive ulcer surgery. A strong case can be made for a definitive ulcer operation at the time of emergency surgery for a perforated chronic duodenal ulcer.