The Late Results in a Series of Forty-Nine Cases of Perforated Gastric and Duodenal Ulcers

At the present time much is being written on the best method of dealing with acute perforations of gastric and duodenal ulcers. For the most part surgeons are divided into two groups : those who advocate simple closure of the ulcer as a routine, and those who advise the performance of a gastroenterostomy in addition. Few, if any, of this latter group would advise gastro-enterostomy on every occasion, but in selected cases they believe that the recovery of the patient is accelerated and the ultimate result more satisfactory than where closure alone is performed. To indicate the divergence of opinions at the present time we may, on the one hand, quote Gibson,1 who adopts simple closure as practically a routine method. Gastro-enterostomy is not done, he says, because few patients have any further trouble with their stomachs after recovery from acute perforation. On the other hand, we find Mills2 stating in a recent paper that he regards gastro-enterostomy as almost a routine part of the operation for perforation. It is doubtful whether at the moment either statement can be accepted as it stands. Most surgeons find that a considerable proportion of their patients treated by simple closure return with evidence of an uncured lesion, but in spite of that they would not subject their patients to a gastro-enterostomy in anything like every case. M'Creery3 has recently summarised the arguments for and against the two methods of treatment. Against gastroenterostomy the following statements have been advanced: