Surgical treatment of perforated duodenal XXXX : a prospective trial between simple closure and definitive surgery.

@entity1 @entity1066
Seventy-eight @entity1 with perforated duodenal @entity1066 were prospectively studied between 1977 and 1982. @entity1 were alternately allocated to receive simple closure (Group I, 33 @entity1 ) and definitive surgery (Group II, 32 @entity1 ). High-risk @entity1 and those whose conditions dictated a definitive operation were excluded. All @entity1 in Group II had a truncal vagotomy and drainage except one who had a proximal gastric vagotomy. There was no death in Group I or Group II; the complication rate and postoperative course were similar. Twenty-seven @entity1 in Group I and 26 @entity1 in Group II were available for follow-up 12 to 80 months after operation, mean 39 months. Good/excellent results were achieved in 30 per cent of Group I compared with 81 per cent of Group II (P less than 0.01). Eighty-five per cent of Group I @entity1 developed recurrent @entity1066 and 33 per cent had already had a second definitive operation. Two @entity1 (8 per cent) in Group II were reoperated upon for recurrent @entity1066 due to an incomplete vagotomy. In a population of @entity1 where long-term follow-up and medical treatment for duodenal @entity1066 is unsatisfactory, truncal vagotomy with drainage should be the treatment of choice for perforation. Simple closure should be reserved for high-risk @entity1 or when the surgeon is inexperienced.
