Outcomes of omental patch repair in large or giant perforated peptic ulcer are comparable to gastrectomy

  • Kai Siang Chan
  • Yi Liang Wang
  • Xue Wei Chan
  • Vishal G. ShelatEmail author
Original Article



Perforated peptic ulcer (PPU) complicates 2 to 10% of patients with peptic ulcer disease and has mortality risk of up to 20%. Omental patch repair is the mainstay of surgical management and gastric resectional procedures are advocated for a large/giant ulcer or suspected malignancy. Emergency gastrectomy is associated with increased morbidity and mortality. The aim of this study is to compare the outcomes of omental patch repair with gastrectomy in patients with large PPU (≥ 20 mm).


A retrospective review of all PPU patients who underwent surgery from January 2008 to December 2014 was done. Patients with PPU < 20 mm were excluded. Patient demographics and perioperative data were recorded. Length of hospital stay, post-operative complications, need for intensive care unit admission and all-cause mortality are reported.


110 patients with a median age of 69.1 (range 28–90) years had PPU ≥ 20 mm. 42 (38.2%) patients presented within 24 h from the onset of abdominal pain. The median American Society of Anaesthesiology score was 3 (range 1–4). 52 patients had omental patch repair and 58 patients had gastrectomy. The overall incidence of intra-abdominal collection, post-operative leakage, re-operation and all-cause mortality was 16.4%, 11.8%, 6.4% and 19.1%, respectively. No difference in post-operative outcomes between the two groups was detected: intra-abdominal collection (p = 0.793), post-operative leakage (p = 0.813), re-operation (p = 0.809) and all-cause mortality (p = 0.736).


Omental patch repair confers similar perioperative outcomes as compared to gastrectomy in patients with large PPU.


Peptic ulcer perforation Large peptic ulcer Omental patch repair Gastrectomy 



Chan Kai Siang performed the statistical analysis of the clinical data and wrote the manuscript. Wang Yi Liang, Chan Xue Wei and Shelat Vishal G. supervised the study and modified the manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare no conflicts of interest.


  1. 1.
    Sung J, Kuipers E, El-Serag H. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther. 2009;29(9):938–46.CrossRefGoogle Scholar
  2. 2.
    Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374(9699):1449–611.CrossRefGoogle Scholar
  3. 3.
    Søreide K, Thorsen K, Søreide J. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014;101(1):e51–e64.CrossRefGoogle Scholar
  4. 4.
    Chung KT, Shelat VG. Perforated peptic ulcer-an update. World J Gastrointest Surg. 2017;9(1):1.CrossRefGoogle Scholar
  5. 5.
    Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg. 2005;29(10):1299–310.CrossRefGoogle Scholar
  6. 6.
    Thorsen K, Glomsaker TB, von Meer A, Søreide K, Søreide JA. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg. 2011;15(8):1329–35.CrossRefGoogle Scholar
  7. 7.
    Anbalakan K, Chua D, Pandya G, Shelat V. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models–are existing models sufficient? A retrospective cohort study. Int J Surg. 2015;14:38–44.CrossRefGoogle Scholar
  8. 8.
    Adachi Y, Mori M, Maehara Y, Matsumata T, Okudaira Y, Sugimachi K. Surgical results of perforated gastric carcinoma: an analysis of 155 Japanese patients. Am J Gastroenterol 1997;92(3):516–8PubMedGoogle Scholar
  9. 9.
    Kasakura Y, Ajani JA, Fujii M, Mochizuki F, Takayama T. Management of perforated gastric carcinoma: a report of 16 cases and review of world literature. Am Surg. 2002;68(5):434.PubMedGoogle Scholar
  10. 10.
    Roviello F, Rossi S, Marrelli D, De Manzoni G, Pedrazzani C, Morgagni P, et al. Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol. 2006;4(1):19.CrossRefGoogle Scholar
  11. 11.
    Gupta S, Kaushik R, Sharma R, Attri A. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5(1):15.CrossRefGoogle Scholar
  12. 12.
    Seow J, Lim Y, Shelat V. Low serum albumin may predict the need for gastric resection in patients with perforated peptic ulcer. Eur J Trauma Emerg Surg. 2017;43(3):293–8.CrossRefGoogle Scholar
  13. 13.
    World Health O. (1992). International statistical classification of diseases and related health problems: 10th revision (ICD-10) [cited 24 January 2019].
  14. 14.
    Ng EK, Lam Y, Sung JJ, Yung M, To K, Chan AC, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231(2):153.CrossRefGoogle Scholar
  15. 15.
    Sebastian M, Chandran VP, Elashaal Y, Sim A. Helicobacter pylori infection in perforated peptic ulcer disease. Br J Surg. 1995;82(3):360–2.CrossRefGoogle Scholar
  16. 16.
    Nomura A, Stemmermann GN, Chyou P-H, Perez-Perez GI, Blaser MJ. Helicobacter pylori infection and the risk for duodenal and gastric ulceration. Ann Int Med. 1994;120(12):977–81.CrossRefGoogle Scholar
  17. 17.
    Shelat VG, Pandya GJ. Nutritional support in dysphagia. In: speyer R and Bogaardt H, editors. Seminars in dysphagia, IntechOpen. 2015. pp. 122–32.
  18. 18.
    Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Reappraising the surgical approach on the perforated gastroduodenal ulcer: should gastric resection be abandoned? J Clin Med Res. 2011;3(5):213.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Christensen S, Riis A, Nørgaard M, Sørensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr. 2007;7(1):8.CrossRefGoogle Scholar
  20. 20.
    Lee FYJ, Leung KL, Lai BSP, Ng SSM, Dexter S, Lau WY. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg. 2001;136(1):90–3.CrossRefGoogle Scholar
  21. 21.
    Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33(1):80–5.CrossRefGoogle Scholar
  22. 22.
    Molloy R, Sonnenberg A. Relation between gastric cancer and previous peptic ulcer disease. Gut. 1997;40(2):247–52.CrossRefGoogle Scholar
  23. 23.
    Lee S, Iida M, Yao T, Shindo S, Nose Y, Akazawa K, et al. Risk of gastric cancer in patients with non-surgically treated peptic ulcer. Scandinavian J Gastroenterol. 1990;25(12):1223–6.CrossRefGoogle Scholar
  24. 24.
    Hansson L-E, Nyrén O, Hsing AW, Bergström R, Josefsson S, Chow W-H, et al. The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med. 1996;335(4):242–9.CrossRefGoogle Scholar
  25. 25.
    Ergul E, Gozetlik EO. Emergency spontaneous gastric perforations: ulcus versus cancer. Langenbeck's Arch Surg. 2009;394(4):643–6.CrossRefGoogle Scholar
  26. 26.
    Kujath P, Schwandner O, Bruch H-P. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbeck's Arch Surg. 2002;387(7–8):298–302.Google Scholar
  27. 27.
    Lanng C, Hansen CP, Christensen A, Thagaard C, Lassen M, Klaerke A, et al. Perforated gastric ulcer. Br J Surg. 1988;75(8):758–9.CrossRefGoogle Scholar
  28. 28.
    So J, Yam A, Cheah W, Kum C, Goh P. Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy. Br J Surg. 2000;87(12):1702–7.CrossRefGoogle Scholar
  29. 29.
    Mak MH, Chew WL, Junnarkar SP, Woon WW, Low J-K, Huey TC, et al. Patient reported outcomes in elective laparoscopic cholecystectomy. Ann Hepato Biliary Pancreat Surg. 2019;23(1):20–33.CrossRefGoogle Scholar
  30. 30.
    Shelat VG, Ahmed S, Chia CL, Cheah YL. Strict selection criteria during surgical training ensures good outcomes in laparoscopic omental patch repair (LOPR) for perforated peptic ulcer (PPU). International Surg. 2015;100(2):370–5.CrossRefGoogle Scholar
  31. 31.
    Lee DJK, Ye M, Sun KH, Shelat VG, Koura A. Laparoscopic versus open omental patch repair for early presentation of perforated peptic ulcer: matched retrospective cohort study. Surg Res Pract. 2016;2016:7.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
  2. 2.Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore

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