A patient with a perforated duodenal ulcer undergoes laparotomy. A 1 cm perforation is found in the anterior wall of the first part of duodenum. What is the preferred immediate surgical procedure?

• A Truncal vagotomy and pyloroplasty incorporating the perforation
• B Partial gastrectomy (Billroth I) to remove the ulcer-bearing area
• C Highly selective vagotomy with perforation closure
• D Graham patch (omental patch repair) with thorough peritoneal lavage ✓

Explanation

Graham patch (omental plug) repair is the definitive procedure of choice for perforated duodenal ulcer in the era of H. pylori eradication and proton pump inhibitors. The perforation is closed with interrupted sutures (or simply plugged with omentum) and secured with an omental pedicle, followed by peritoneal lavage. Vagotomy has been largely abandoned as definitive acid-reducing surgery is no longer needed routinely when Helicobacter pylori is eradicated postoperatively. Definitive surgery (gastrectomy, vagotomy) is reserved for failed medical therapy or giant/chronic ulcers.

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.