A 55-year-old man undergoes emergency laparotomy for a perforated duodenal ulcer. The perforation is 8 mm in the anterior wall of the first part of the duodenum. The optimal surgical procedure is:

• A Pyloroplasty with vagotomy
• B Subtotal gastrectomy with Billroth II reconstruction
• C Simple closure with omentoplasty only if the patient is haemodynamically unstable
• D Graham's omentopexy patch closure of the perforation ✓

Explanation

In the era of effective H. pylori eradication and proton pump inhibitor therapy, the definitive treatment for perforated duodenal ulcer is simple closure with a Graham omentopexy patch, in which an adjacent tongue of omentum is sutured over the perforation to reinforce and seal it. Definitive ulcer surgery (vagotomy, gastrectomy) is no longer routinely performed at the time of perforation repair because medical management post-operatively is highly effective. Simple patch closure should be performed regardless of haemodynamic status if the perforation is amenable.

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.