What is the preferred surgery for treatment of perforated gastric ulcer?
- Excision of the ulcer with or without vagotomy and drainage. The major distinction between surgical management of perforated duodenal and perforated gastric ulcers is that in all cases of perforated gastric ulcers, carcinoma must be excluded.
- Thus all perforated gastric ulcers must undergo biopsy or resection. One option is to perform a wedge resection as diagnostic biopsy.
- Controversy exists as to whether a definitive ulcer operation should be added to this procedure, with most surgeons in favor of a definitive acid-reducing procedure in type II or III variant.
- An alternative for perforated antral ulcers is antrectomy (with inclusion of the ulcer in the resection), to which truncal vagotomy may be added if the patient is an acid hypersecretor.
- The decision for the type of operation should be based on an individual patient, taking into account the patient’s comorbidities, age, and severity at presentation.
