Proximal Gastric vagotomy without drainage for treatment of perforated duodenal ulcer.

One hundred and nine patients with perforated duodenal ulcer were treated by operation between 1973 and 1980. The operations performed included simple closure in 37 patients, vagotomy and drainage or gastric resection in 12 patients, and proximal gastric vagotomy without drainage and with omental patch of the perforation in 60 patients. Patients who were treated by proximal gastric vagotomy have been observed for 1-8 yr and form the basis of this study. There was no operative mortality. One patient with a postoperative infection required secondary drainage and a second patient with intestinal obstruction required lysis of adhesions. There were no other important complications. Persistent mild dumping occurred in 1 patient. Diarrhea was not a complication for any patient. One patient developed a recurrent ulcer and underwent truncal vagotomy and pyloroplasty. All patients except the patient with a recurrent ulcer had a Visick grading or I or II. Proximal gastric vagotomy, omental patch of the ulcer, and no drainage procedure is the ideal operation for patients who are candidates for definitive treatment of a perforated duodenal ulcer.