Radical Versus Conservative Surgical Management of Acute Perforated Peptic Ulcer

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Abstract
The poor results obtained with the conservative surgical management of acute gastroduodenal perforations have produced an increased interest in the use of a more radical procedure. Primary gastrectomy for acute perforations is gaining favor and, with careful preoperative evaluation, can be employed with relative safety. The authors advise primary gastrectomy, with observance of certain safety factors, for all patients with acute perforations and a history of chronic ulcer suggestive of intractability. This procedure is not recommended to the exclusion of conservative surgical management, but the importance of careful selection and individualization of patients is stressed.