Perforated peptic ulcer: to close or patch – a century-old controversy

Abstract

Background: This study aimed to determine which surgical technique is associated with more favorable outcomes for the repair of perforated peptic ulcers. Methods: A retrospective medical record review of patients who underwent surgery for perforated peptic ulcers at the Mayo Clinic Rochester campus between 2004 and 2021 was performed. Results: The final analysis included 277 patients: 182 underwent suture closure of the perforation, 55 underwent patch-only repair, 15 underwent gastrectomy with reconstruction, 14 underwent wedge resection, and 11 underwent other techniques. No leaks were observed in patients who underwent stapled wedge resection. Among patients who underwent repair of the perforation (n = 237), 3 variables associated with the leak on univariate analysis were included in a logistic regression model. All 3 variables were independently associated with a leak: lack of suture closure of the perforation (odds ratio [OR], 7.0; 95% CI, 2.5–19.1), immunosuppression (OR, 5.5; 95% CI, 1.7–17.6), and lactate levels (OR, 1.4; 95% CI, 1.1–1.7). Conclusion: When both sutured and patch-only closure techniques are feasible for a perforated peptic ulcer, sutured closure is associated with a lower risk of leakage. However, given our study's retrospective, single-institution nature, the findings should be interpreted with caution.