HP26P MANAGEMENT OF PERFORATED GASTRIC ULCERS IN A SYDNEY TERTIARY REFERRAL CENTRE

Abstract

Background: Traditional surgical teaching recommends partial gastrectomy rather than omental patch repair for the management of perforated gastric ulcer. This study analysed the outcome of these two operative procedures in a tertiary referral centre.Methods: A retrospective analysis of a prospective collected database was performed on all patients who presented to Westmead Hospital with perforated gastric ulcer between January 1992 and December 2008.Results: All 21 patients with perforated gastric ulcers underwent surgical management. Omental patch repair was performed in 15 patients (71%) and 6 patients (29%) underwent a partial gastrectomy. There was no significant difference in premorbid illnesses and risk factors other than smoking being higher in the omental patch repair group (p = 0.02). The operating time was significantly lower in the omental patch repair group compared to that of partial gastrectomy group (87 minutes versus 150 minutes; p = 0.02). Partial gastrectomies were performed more often when the consultant surgeons were performing the surgery (p = 0.04). The overall mortality rate was 14% with no significant difference in mortality rate between the two groups. (1/6 versus 2/16; p = 0.84). Omental patch repair group had a significantly lower (p = 0.04) morbidity rate compared to partial gastrectomy group (53% versus 100%; p = 0.04). None of these patients had malignant perforated gastric ulcers.Conclusion: Perforated gastric ulcer is uncommon. Omental patch repair was associated with faster operating time, lower morbidity rate and similar mortality rate compared to that of partial gastrectomy. Omental patch repair merits consideration as the first line therapy in patients with perforated gastric ulcer.