A 35-year-old woman presents with a perforated duodenal ulcer. Intraoperative findings show a 1 cm anterior first-part duodenum perforation with faecal-free pneumoperitoneum of 6 hours duration. She is haemodynamically stable. The most appropriate definitive surgical procedure is:
- A Vagotomy and pyloroplasty
- B Gastric resection (Billroth I)
- C Simple closure (Graham's patch omental repair) and thorough peritoneal lavage ✓
- D Truncal vagotomy with gastroenterostomy
Correct answer: C. Simple closure (Graham's patch omental repair) and thorough peritoneal lavage
Explanation
In the era of effective H. pylori eradication and PPI therapy, simple closure with Graham's omental patch and peritoneal lavage is the definitive surgical treatment for perforated peptic ulcer. Definitive anti-ulcer surgery (vagotomy) is no longer routinely performed since recurrence is prevented by post-operative H. pylori eradication and PPI therapy, avoiding the complications of more extensive surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.