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April 1966

Acute Gastroduodenal Perforation: Comparative Study of Treatment With Simple Closure, Subtotal Gastrectomy, and Hemigastrectomy and Vagotomy

Author Affiliations

From the Cora and Webb Mading Department of Surgery, Baylor University College of Medicine, and the Ben Taub General, Jefferson Davis, and Veterans Administration hospitals, Houston.

Arch Surg. 1966;92(4):449-455. doi:10.1001/archsurg.1966.01320220005002

THE USE of antibiotics, improved understanding of fluid and electrolyte problems, and liberal use of whole blood have changed the prognosis of gastroduodenal perforation as compared to 30 years ago. This complication of ulcer disease remains, nevertheless, one of the most catastrophic causes of generalized peritonitis. Despite a voluminous literature reporting experiences with thousands of patients, there still is no concensus concerning treatment. Basically there are three methods which have been proposed: (1) nonoperative treatment, (2) simple closure, and (3) definitive operations to treat the underlying disease as well as the acute complication.6 Our experience with nonoperative treatment has been distressing, and we mention it only to condemn. Irrespective of whether or not the perforation is ultimately sealed by omentum, this method fails to accomplish an important therapeutic maneuver, cleansing of the peritoneal cavity.

In 1949 most surgeons in the United States agreed that simple closure was the treatment

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