PERFORATED GASTRIC-ULCERS - RESECTION COMPARED WITH SIMPLE CLOSURE

One hundred thirty-four patients with perforated gastric ulcers who un derwent emergency surgery at a tertiary referral center during a 20-ye ar period were reviewed. Short-term outcome of 94 patients whose perfo ration was simply closed was compared with 40 who had a gastrectomy. M orbidity (simple closure 51%; resection 45%) and mortality (simple clo sure 10.6%; resection 7.5%) were similar, but four deaths after simple closure were procedure-related. In patients older than 65 years, morb idity (67%) and mortality (24%) increased significantly. The higher mo rtality in the elderly was particularly apparent after simple closure (29% vs 11%), but this may reflect selection bias. Simple closure is s afe and effective in the majority of patients with perforated gastric ulcers. However, our data indicate that gastrectomy can be performed s afely even in high risk cases and should be considered where there is a well documented history of chronicity or when the nature of the ulce r, or associated ulcer hemorrhage, preclude safe simple closure.