Perforated Peptic Ulcer: Surgical Approach and Current Management Strategies

• DOI: https://doi.org/10.22533/at.ed.15953225221010

• Palavras-chave: Perforated Peptic Ulcer; Surgical Approach; Laparoscopy; Omentopexy; Omental Tamponade; Peritonitis; Surgical Emergency.

• Keywords: Perforated Peptic Ulcer; Surgical Approach; Laparoscopy; Omentopexy; Omental Tamponade; Peritonitis; Surgical Emergency.

• Abstract:

  Perforated peptic ulcer (PPU) is a serious complication of ulcer disease and a surgical emergency with high morbidity and mortality rates. Although the overall incidence of ulcers has decreased, perforation rates remain stable, often associated with Helicobacter pylori infection and NSAID use. The gold standard treatment is surgical intervention, with the laparoscopic approach recommended as the first line for stable patients, demonstrating advantages such as shorter hospital stays and lower postoperative morbidity rates compared to open surgery. The most common repair technique is simple suture with omentopexy. However, for giant perforations (> 2 cm), a significant surgical challenge, the omental plugging technique has proven superior, with a significant reduction in complications and mortality. In children, PPU is mostly linked to H. pylori infection. As minimally invasive surgery becomes more established, endoscopic repair techniques are emerging as future alternatives for selected cases.