Surgical Management of Perforated Peptic Ulcers

Perforated peptic ulcer remains a surgical emergency with substantial morbidity and mortality worldwide. Prompt diagnosis—often by radiological detection of free intraperitoneal air—and rapid resuscitation precede definitive intervention. Surgical options range from simple omental patch closure to definitive ulcer surgery for high-risk or recurrent lesions. Advances in minimally invasive techniques have shifted practice towards laparoscopic repair in stable patients, offering reduced wound complications and shorter hospital stays. Critical determinants of outcome include patient age, physiological reserve, degree of peritoneal contamination and delay to surgery. Careful risk stratification, employing clinical scoring systems alongside biochemical and radiological assessment, guides the choice of open versus laparoscopic approach, the extent of peritoneal decontamination and the need for postoperative intensive therapy. Integration of risk scales with antimicrobial stewardship and Helicobacter pylori eradication protocols underpins a multidisciplinary strategy to reduce postoperative infectious complications and optimise recovery.

Research from Nature Portfolio

Recent studies have focused on refining laparoscopic techniques for peritoneal decontamination during repair of perforated peptic ulcers. A comparative analysis of peritoneal irrigation versus gauze wiping with suction in a high-volume centre found that full irrigation prolonged operative time and increased the number of drains and intra-abdominal abscesses, whereas targeted gauze wiping and suction achieved equivalent decontamination with fewer drains and no rise in infectious complications. These findings support a more selective approach to lavage, minimising operative duration and postoperative morbidity without compromising safety.

Surgical Management of Perforated Peptic Ulcers publication trend

The graph below shows the total number of articles in surgical management of perforated peptic ulcers across all publications each year (not limited to Nature Index journals).

Technical terms

Omental patch: A piece of the greater omentum used to cover and reinforce a small ulcer perforation.

Laparoscopic repair: Minimally invasive closure of an ulcer perforation using small ports, camera assistance and specialised instruments.

Peritoneal irrigation: Washing out the peritoneal cavity with fluid during surgery to remove contamination.

Peritonitis: Inflammation of the peritoneum, usually secondary to bacterial contamination from perforated viscera.

References

1. Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease. Scientific Reports (2023).
2. Simple severity scale for perforated peptic ulcer with generalized peritonitis: a derivation and internal validation study. International Journal of Surgery (2024).
3. Perforated and bleeding peptic ulcer: WSES guidelines. World Journal of Emergency Surgery (2020).
4. Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study. BMJ Open (2018).