The natural history of the perforated duodenal ulcer treated by suture plication.

This retrospective study of 174 patients with proven duodenal ulcer perforation was undertaken to delineate the natural history of those patients primarily managed by suture plication. During this 25-year period, 122 patients (70%) were treated with suture plication and 52 (30%) underwent a definitive procedure. There were 13 deaths in the overall group (7.4%) of which the mortality was 6.5% in the plicated group and 9.6% in the definitive group. Of the 122 patients treated with suture plication, 48% either 1) died of ulcer complications later, 2) required reoperation for ulcer disease, or 3) were under active treatment for ulcer symptoms. The reperforation rate in the entire series was 9% and the reoperation rate 32%. Suture plication is a time-honored, life-saving procedure, however, definitive surgery is a superior form of long-term management of the perforated duodenal ulcer patient.