What is the preferred surgery for treatment of a perforated duodenal ulcer?
- The preferred operation is a simple patch (Graham patch) of the perforation, especially in the setting of shock or in patients with multiple comorbidities undergoing an emergent operation, when prolonged operative time can be detrimental.
- In patients who have undergone medical therapy to eradicate H. pylori, a reasonable approach for a perforated duodenal ulcer is truncal vagotomy and pyloroplasty, with incorporation of the perforation into the pyloroplasty closure.
- This relatively simple procedure requires a short operative time.
- In the ideal surgical candidate, highly selective vagotomy with patch closure of the perforation is recommended, although this procedure requires a high degree of surgical expertise.
- Patients who have not been treated for H. pylori prior to perforation should undergo repair and Graham patch of a perforated duodenal ulcer as stated previously with postoperative H. pylori eradication therapy, in lieu of a definitive ulcer operation.
