Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 Sep;196(3):338–344. doi: 10.1097/00000658-198209000-00013

Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial.

J Boey, N W Lee, J Koo, P H Lam, J Wong, G B Ong
PMCID: PMC1352612  PMID: 7114938

Abstract

A prospective, randomized, double-blind trial was conducted in 101 patients to evaluate the safety and benefits of immediate definitive surgery for perforated duodenal ulcers. These patients, who were judged by predefined criteria to be medically fit and to have perforations in chronic ulcers, were randomized to undergo simple closure (35 patients), truncal vagotomy and drainage (VD) (32 patients), or proximal gastric vagotomy with closure (PGV) (34 patients). Patients were followed with endoscopic assessment for up to 39 months. There was no mortality and only a few minor postoperative complications. At 39 months follow-up, the cumulative rates of recurrence were 63.3%, 11.8% and 3.8% after closure, VD, and PGV, respectively (p less than 0.001). With the exception of the one recurrence after PGV, all relapses were symptomatic, and eight of these 18 required reoperation. Relapse rates and Visick scores between VD and PGV were significantly different. Both safe as well as effective, immediate, nonresective, definitive operation is indicated for good-risk patients who have perforations in chronic duodenal ulcers.

Full text

PDF
338

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amdrup E., Jensen H. E., Johnston D., Walker B. E., Goligher J. C. Clinical results of parietal cell vagotomy (highly selective vagotomy) two to four years after operation. Ann Surg. 1974 Sep;180(3):279–284. doi: 10.1097/00000658-197409000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baekgaard N., Lawaetz O., Poulsen P. E. Simple closure or definitive surgery for perforated duodenal ulcer. Scand J Gastroenterol. 1979;14(1):17–20. doi: 10.3109/00365527909179841. [DOI] [PubMed] [Google Scholar]
  3. Boey J., Wong J., Ong G. B. A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg. 1982 Mar;195(3):265–269. doi: 10.1097/00000658-198203000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. DEAN A. C., CLARK C. G., SINCLAIR-GIEBEN A. H. The late prognosis of perforated duodenal ulcer. Gut. 1962 Mar;3:60–64. doi: 10.1136/gut.3.1.60. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Donovan A. J., Vinson T. L., Maulsby G. O., Gewin J. R. Selective treatment of duodenal ulcer with perforation. Ann Surg. 1979 May;189(5):627–636. doi: 10.1097/00000658-197905000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Donovan A. J., Vinson T. L., Maulsby G. O., Gewin J. R. Selective treatment of duodenal ulcer with perforation. Ann Surg. 1979 May;189(5):627–636. doi: 10.1097/00000658-197905000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Drury J. K., McKay A. J., Hutchison J. S., Joffe S. N. Natural history of perforated duodenal ulcers treated by suture closure. Lancet. 1978 Oct 7;2(8093):749–750. doi: 10.1016/s0140-6736(78)92643-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ferraz E. M., Ferreira Filho H. A., Bacelar T. S., Lacerda C. M., Ponce de Souza A., Kelner S. Proximal gastric vagotomy in stenosed or perforated duodenal ulcer. Br J Surg. 1981 Jul;68(7):452–454. doi: 10.1002/bjs.1800680703. [DOI] [PubMed] [Google Scholar]
  9. Goligher J. C., Hill G. L., Kenny T. E., Nutter E. Proximal gastric vagotomy without drainage for duodenal ulcer: results after 5-8 years. Br J Surg. 1978 Mar;65(3):145–151. doi: 10.1002/bjs.1800650302. [DOI] [PubMed] [Google Scholar]
  10. Greco R. S., Cahow C. E. Alternatives in the management of acute perforated duodenal ulcer. Am J Surg. 1974 Jan;127(1):109–114. doi: 10.1016/0002-9610(74)90019-1. [DOI] [PubMed] [Google Scholar]
  11. Humphrey C. S., Johnston D., Walker B. E., Pulvertaft C. N., Goligher J. C. Incidence of dumping after truncal and selective vagotomy with pyloroplasty and highly selective vagotomy without drainage procedure. Br Med J. 1972 Sep 30;3(5830):785–788. doi: 10.1136/bmj.3.5830.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Illingworth C. F., Scott L. D., Jamieson R. A. Progress after Perforated Peptic Ulcer. Br Med J. 1946 May 25;1(4455):787–790. [PMC free article] [PubMed] [Google Scholar]
  13. Jarrett F., Donaldson G. A. The ulcer diathesis in perforated duodenal ulcer disease. Experience with 252 patients during a twenty-five year period. Am J Surg. 1972 Apr;123(4):406–410. doi: 10.1016/0002-9610(72)90191-2. [DOI] [PubMed] [Google Scholar]
  14. Johnston D., Lyndon P. J., Smith R. B., Humphrey C. S. Highly selective vagotomy without a drainage procedure in the treatment of haemorrhage, perforation, and pyloric stenosis due to peptic ulcer. Br J Surg. 1973 Oct;60(10):790–797. doi: 10.1002/bjs.1800601010. [DOI] [PubMed] [Google Scholar]
  15. Jordan G. L., Jr, DeBakey M. E., Duncan J. M., Jr Surgical management of perforated peptic ulcer. Ann Surg. 1974 May;179(5):628–633. doi: 10.1097/00000658-197405000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Jordan P. H., Jr, Hendenstedt S., Korompai F. L., Lundquist G. Vagotomy of the fundic gland area of the stomach without drainage. A definitive treatment for perforated duodenal ulcer. Am J Surg. 1976 May;131(5):523–526. doi: 10.1016/0002-9610(76)90002-7. [DOI] [PubMed] [Google Scholar]
  17. Jordan P. H., Jr, Korompai F. L. Evolvement of a new treatment for perforated duodenal ulcer. Surg Gynecol Obstet. 1976 Mar;142(3):391–395. [PubMed] [Google Scholar]
  18. Kirkpatrick J. R., Bouwman D. L. A logical solution to the perforated ulcer controversy. Surg Gynecol Obstet. 1980 May;150(5):683–686. [PubMed] [Google Scholar]
  19. Mark J. B. Factors influencing the treatment of perforated duodenal ulcer. Surg Gynecol Obstet. 1969 Aug;129(2):325–330. [PubMed] [Google Scholar]
  20. PALUMBO L. T., SHARPE W. S. Acute perforated peptic ulcer: evaluation of 160 consecutive patients treated by closure. Surgery. 1961 Dec;50:863–868. [PubMed] [Google Scholar]
  21. Rees J. R., Swan K. G., Thorbjarnarson B. Perforated duodenal ulcer. Am J Surg. 1970 Dec;120(6):775–779. doi: 10.1016/s0002-9610(70)80047-2. [DOI] [PubMed] [Google Scholar]
  22. SEELEY S. F., CAMPBELL D. Nonoperative treatment of perforated peptic ulcer; a further report. Surg Gynecol Obstet. 1956 May;102(5):435–446. [PubMed] [Google Scholar]
  23. Sawyers J. L., Herrington J. L., Jr, Burney D. P. Proximal gastric vagotomy compared with vagotomy and antrectomy and selective gastric vagotomy and pyloroplasty. Ann Surg. 1977 Oct;186(4):510–517. doi: 10.1097/00000658-197710000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sawyers J. L., Herrington J. L., Jr Perforated duodenal ulcer managed by proximal gastric vagotomy and suture plication. Ann Surg. 1977 Jun;185(6):656–660. doi: 10.1097/00000658-197706000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sawyers J. L., Herrington J. L., Mulherin J. L., Jr, Whitehead W. A., Mody B., Marsh J. Acute perforated duodenal ulcer. An evaluation of surgical management. Arch Surg. 1975 May;110(5):527–530. doi: 10.1001/archsurg.1975.01360110073013. [DOI] [PubMed] [Google Scholar]
  26. Sirinek K. R., Levine B. A., Schwesinger W. H., Aust J. B. Simple closure of perforated peptic ulcer. Still an effective procedure for patients with delay in treatment. Arch Surg. 1981 May;116(5):591–596. doi: 10.1001/archsurg.1981.01380170071012. [DOI] [PubMed] [Google Scholar]
  27. Skarstein A., Hoisaeter P. A. Perforated peptic ulcer: a comparison of long term results following partial gastric resection or simple closure. Br J Surg. 1976 Sep;63(9):700–703. doi: 10.1002/bjs.1800630908. [DOI] [PubMed] [Google Scholar]
  28. TAYLOR H. Guest lecture: the nonsurgical treatment of perforated peptic ulcer. Gastroenterology. 1957 Sep;33(3):353–368. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES