Definitive surgery for perforated peptic ulcer in the elderly

Perforated gastroduodenal ulcer is a catastrophe, especially in aged patients. Presenting a major challenge to surgeons, there is still no agreement among them about which procedure they prefer. Analyzing data from this hospital, presents an attempt to identify operative method which would have better outcome with low mortality and ulcer-recurrence rate. Addressing ulcer recurrence and results, definitive surgery is the choice of operation for the patients with perforated peptic ulcer. However, the elderly might not be able to tolerate or benefit from a lengthy operation without mortality. A retrospective study was performed of 115 patients, over 65 years of age, with benign ulcer perforation. All were allocated to receive either simple closure (15 patients) or definitive operation (100 patients). Fifty-seven of the total patients were available to follow-up, and 53 received gastroscopy then. The surgical mortality rate for the simple closure and definitive surgery groups was 48% and 12%, respectively. The univariate (x²) and multivariate analysis showed perioperative shock, perforated ulcer size, and associated systemic diseases played a determining role in mortality. In the definitive surgery group, 90% of patients who received truncal vagotomy with gastrectomy, and 60% of those who received truncal vagotomy plus drainage procedure, had good or excellent results defined by a modified Visick classification. Ulcer recurrence rate was 11% and 32% in these two subgroups, respectively. The truncal vagotomy with gastrectomy had a lower ulcer recurrent rate (11%) and better result. Further, its mortality rate (13%) compared with those of other definitive surgery groups was not significant.