UPPER GI CONDITION · CONDITION GUIDE

Peptic Ulcer

Q: Is surgery the only option for a perforated peptic ulcer?

In the majority of cases, emergency surgery with laparoscopic Graham patch repair is required for perforated peptic ulcer with peritonitis. In very selected, haemodynamically stable patients without generalised peritonitis confirmed by CT, non-operative management with antibiotics, proton pump inhibitors, and close monitoring may be attempted, but surgical repair remains the gold standard.

Q: Will I need long-term medication after peptic ulcer surgery?

H. pylori eradication therapy — a short course of antibiotics and a proton pump inhibitor — is prescribed after surgery to treat the underlying infection and prevent recurrence. Long-term PPI therapy is recommended for high-risk patients, and NSAIDs should be avoided or taken with gastroprotection.

Q: How soon can I eat normally after perforated ulcer repair?

Clear fluids are commenced once bowel function returns, typically on day 1–2 post-operatively. Soft diet is introduced over 3–5 days. Most patients are eating normally within 1–2 weeks and are discharged within 3–5 days after laparoscopic repair.

Mucosal erosion of the stomach or duodenum causing pain and potentially serious complications including perforation and bleeding — surgical repair required for perforated ulcers.

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Surgical Management for Peptic Ulcers by Dr. Tagore

Common UPPER GI CONDITION

45–90 Min PROCEDURE DURATION

3–5 Days HOSPITAL STAY

ABOUT THIS CONDITION

What is Peptic Ulcer?

A peptic ulcer is a break in the mucosal lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer), resulting from an imbalance between acid production and mucosal defence. H. pylori infection and NSAID use are the principal causes. Most ulcers are managed medically with proton pump inhibitors and H. pylori eradication. Surgery is required for the serious complications of perforation and uncontrolled haemorrhage. Dr. Tagore Mohan Grandhi performs emergency laparoscopic repair of perforated peptic ulcers at Lux Hospitals, Hyderabad. The Graham patch repair — covering the perforation with an omental patch — is the standard laparoscopic technique, providing rapid definitive closure with minimal morbidity in haemodynamically stable patients.

SIGNS TO WATCH

Common Symptoms

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Symptoms that need attention

Epigastric burning or gnawing pain, often related to meals Heartburn, nausea, and bloating Sudden severe generalised abdominal pain with peritonism in perforation Vomiting blood (haematemesis) or dark tarry stools (melaena) from bleeding Loss of appetite and unintentional weight loss Board-like abdominal rigidity in perforated peptic ulcer

WHY IT HAPPENS

Causes & Risk Factors

Helicobacter pylori infection disrupting mucosal defence mechanisms
Chronic NSAID or aspirin use reducing prostaglandin-mediated mucosal protection
Excess gastric acid secretion (Zollinger-Ellison syndrome in rare cases)
Smoking increasing ulcer risk and impairing healing
Psychological stress and critical illness (stress ulcers) in ICU patients
Alcohol and corticosteroid use as contributing factors

CLINICAL DETAILS

KeyFacts

Common Causes

H. pylori infection and NSAID use

Emergency Indication

Perforation causing peritonitis

Surgical Technique

Laparoscopic Graham patch omental repair

Medical Follow-up

H. pylori eradication mandatory post-repair

Recovery

Discharge in 3–5 days; return to activity in 2–3 weeks

Hospital

Available at Lux Hospitals, Hitech City, Hyderabad

HOW WE TREAT IT

Treatment Approach

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Laparoscopic Graham Patch Repair

Laparoscopic repair of a perforated peptic ulcer using an omental (Graham) patch closes the perforation, clears peritoneal contamination, and avoids the large incision of open surgery. Dr. Grandhi performs emergency laparoscopic Graham patch repair with excellent outcomes, early recovery, and significantly reduced post-operative pain compared to open repair.

Available at Lux Hospitals, Hitech City, Hyderabad

1

Diagnosis & Emergency Resuscitation

Erect chest X-ray or CT abdomen confirms free gas under the diaphragm, indicating perforation. Intravenous fluids, antibiotics, analgesia, and nasogastric decompression are commenced while preparing for surgery.
2

Emergency Laparoscopic Repair

The peritoneal cavity is irrigated laparoscopically. The perforation is identified and closed with sutures. A tongue of omentum (Graham patch) is sutured over the repair to reinforce closure.
3

Post-operative Intensive Care

Post-operatively, patients are monitored in a high-dependency setting. IV antibiotics and proton pump inhibitors are continued. Oral fluids are commenced when bowel function returns.
4

H. pylori Eradication & Follow-up

H. pylori eradication therapy is prescribed on discharge. Upper GI endoscopy at 4–6 weeks confirms ulcer healing. Long-term PPI therapy and NSAID cessation prevent recurrence.

AVAILABLE TREATMENTS

TreatmentOptions

Laparoscopic Repair of Perforated Ulcer (Graham Patch)

Emergency laparoscopic closure of a perforated gastric or duodenal ulcer using an omental patch with peritoneal washout.

Partial Gastrectomy

Resection of the ulcer-bearing portion of the stomach for giant gastric ulcers suspicious for malignancy, or for refractory ulcers not amenable to simple repair.

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COMMON QUESTIONS

Frequently Asked Questions

Is surgery the only option for a perforated peptic ulcer?+

Will I need long-term medication after peptic ulcer surgery?+

How soon can I eat normally after perforated ulcer repair?+

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