Surgical Management of Perforated Peptic Ulcer; Closure with Omental Patch versus Definitive Repair with Vagotomy and Gastrojejunostomy: A Comparative Study

Abstract

Background : The perforation of peptic ulcer is a common and serious life threatening surgical emergency. Up-till now no consensus was reached regarding the best practice in management of perforated peptic ulcer. The aim of this study is to evaluate and compare between both management strategies of perforated peptic ulcer; performing simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors versus performing definitive repair of perforated peptic ulcer (closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy to discover a proper management strategy of perforated peptic ulcer. Patients and Methods : In the current study we included 30 patients which were divided into 2 groups: group 1 included 15 patients where we managed them by simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors and group 2 included 15 patients where we performed closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy. Results : We found that younger patient underwent vagotomy and gastro-jejunostomy technique (p < 0.001), the technique of vagotomy and gastro-jejunostomy has a longer duration than closure with omental patch acid reduction (p = 0.009). There was a highly statistically significant association between both surgical procedures regarding; duration of hospital stay (longer in case of definitive repair) (p < 0.001). Conclusions : Peptic ulcer perforation could be safely managed by primary closure and covering by omentum in addition to medical treatment of H. pylori infection and inhibition of acid secretion especially in old patients with comorbid condition who presented late or with shock.