A patient with a perforated duodenal ulcer undergoes omental patch repair (Graham patch). Post-operatively, which additional treatment must be initiated to reduce the risk of recurrent ulceration?

• A Long-term proton pump inhibitor (PPI) therapy alone
• B Vagotomy and pyloroplasty at the same operation
• C Long-term H2 receptor antagonist therapy
• D H. pylori eradication therapy if H. pylori-positive, followed by PPI course ✓

Explanation

H. pylori infection is present in approximately 70-80% of perforated duodenal ulcers. Graham patch repair addresses the perforation but does not eliminate the underlying cause. Post-operative H. pylori testing (urea breath test or biopsy) and eradication therapy (triple or quadruple regimen) followed by a 4-8 week PPI course dramatically reduce ulcer recurrence from ~70% to <5%. Elective acid-reducing procedures (vagotomy) are rarely performed in modern practice for perforated ulcers.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.