Surgical Scales: Primary Closure versus Gastric Resection for Perforated Gastric Ulcer ‑ A Surgical Debate

Abstract

Perforated gastric ulcer is one of the most life‑threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and  intraoperative debates. The subject of the debate is a 59‑year‑old male patient who presented with perforated giant gastric ulcer complicated by generalized peritonitis and severe sepsis. The debate is based on a systematized table dividing all factors into three groups and putting them on surgical scales. Pathology‑related factors influencing the decision‑making are size and site of perforation, local tissue inflammation, signs of malignancy, simultaneous complications of peptic ulcer, peritonitis, and sepsis. Besides these factors, patient‑ and healthcare‑related factors should also be considered.

Keywords: Gastrectomy, gastric resection, gastric ulcer, giant ulcer, perforated ulcer, primary ulcer repair