Perforated gastric ulcers: resection compared with simple closure.

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