European Journal of Cardiovascular Medicine

Background In this study, we wanted to evaluate the surgical management of peptic perforation and compare between simple closure and definitive surgery.  Methods This was a hospital based comparative study conducted among 154 patients who presented with peptic perforations to the Department of Surgery, Heritage Institute of Medical Sciences, Uttar Pradesh, from March 2020 to February 2021, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.  Results The highest incidence was recorded in poor socio-economic status. There was no previous history of peptic ulcer. 91 % of the patients were operated within 72 hours of perforation. The commonest form of presentation was pain abdomen, which was present in all the patients. Gas under the diaphragm was present in 86 % of cases. Gastrografin study was done in some of patients to facilitate diagnosis. Bilious fluid came out in four quadrants peritoneal tap. 67.5 % of the perforations were less than 5 mm in size and 96 % of perforations were less than 10 mm in size. Out of 154 cases, 52 patients (34 %) had post-operative complications. In group -A, mortality was 11.5 % and 7 % in Group - B. Average hospital stay in Group - A was 11.73 days and average hospital stay in group B was 13.05 days. Dyspepsia occurred in 58.4 % of patients; hematemesis and/Melena in 15 (9 %) cases, pyloric stenosis in 4 (2.6 %) cases and re-perforation in 2 (1.7 %) cases in two years of follow up. Ulcer recurrence occurred in 30.5 % of patients and was treated by simple closure in 2 years of follow up; but there was no recurrence in patients treated by definitive surgery during this period.  Conclusion Simple closure of the perforation with drainage of peritoneal cavity is safe for those in whom definitive surgery is relatively contraindicated like, elderly patients presenting with moderate to severe shock, after 48 hours of perforation and with concomitant medical illness. Therefore, painstaking efforts are made in selecting proper cases for definitive surgery, so that both immediate and long term good result can be obtained.