Repair of a perforated ulcer (Surgical repair of a perforated peptic ulcer)
An emergency operation to close a hole that has formed where a stomach or duodenal ulcer has burst through the wall, and to clean the abdomen.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It is an emergency operation to close a hole from a burst stomach or duodenal ulcer and to clean infection from the abdomen.
- Most repairs use a patch of the body's own fatty tissue (omentum) over the hole; it can be done by keyhole or open surgery.
- This is serious surgery done because someone is acutely unwell — it is not elective and carries significant risk, especially with delay, older age or shock.
- Afterwards, acid-lowering medicines and treating Helicobacter pylori help the ulcer heal and prevent it happening again.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Closes the leak and stops stomach contents spilling into the abdomen
Surgery is almost always needed; non-surgical management is only considered in carefully selected, stable patients under close monitoring.
You are monitored closely, sometimes in high-dependency or intensive care, with fluids, antibiotics and pain relief. A stomach tube and drain may be in...
Close monitoring after surgery, with escalation to higher-level care if needed.
You are monitored closely, sometimes in high-dependency or intensive care, with fluids, antibiotics and pain...
Eating and drinking are reintroduced gradually as the bowel starts working. Early gentle movement helps prevent...
Wounds heal and energy slowly returns at home. You build up activity gradually and continue acid-lowering...
Most people return towards normal activity, though tiredness can linger. A test and treatment for Helicobacter...
What is repair of a perforated ulcer?
A peptic ulcer is a sore in the lining of the stomach or the first part of the small bowel (the duodenum). If it eats all the way through the wall, it makes a hole — a perforation. Stomach contents then leak into the abdomen, causing sudden severe pain and a serious infection (peritonitis). This is a surgical emergency.
The operation closes the hole and cleans the abdomen. Most often a small piece of the fatty apron that hangs from the bowel (the omentum) is stitched over the hole to seal it — called an omental or Graham patch. The surgeon also washes out the leaked contents to control infection.
This is not a planned or elective procedure and not something arranged privately — it is done urgently to save life and prevent overwhelming infection. After surgery, treatment usually includes acid-lowering medicines and clearing the bacterium Helicobacter pylori, which is a common underlying cause.
Because people are often very unwell by the time the ulcer perforates, this is serious surgery with real risks, and recovery depends a lot on age, other health problems and how quickly treatment started.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Open omental (Graham) patch repair
Through a cut in the tummy, a piece of omentum is stitched over the hole and the abdomen is washed out. A long-established, reliable approach, especially when someone is very...
Laparoscopic (keyhole) repair
The same patch repair done through small cuts using a camera, where expertise and the patient's condition allow. May mean less wound pain and a quicker recovery in suitable...
Washout (peritoneal lavage)
Thorough cleaning of the abdomen to remove leaked stomach contents and reduce infection, done as part of either approach.
Larger or more complex surgery
If the hole is large or the tissue poor, more extensive surgery (such as removing part of the stomach) is occasionally needed.
Preparing for your surgery
- There is usually little time to prepare — this is an emergency, and you will be assessed and resuscitated quickly.
- You will be given fluids through a drip, often antibiotics, strong pain relief and a tube into the stomach to drain it.
- Blood tests, a chest X-ray or a CT scan are usually done to confirm the diagnosis and plan surgery.
- The team will explain the operation and its serious risks to you or, if you are too unwell, to your next of kin.
- Tell the team about your medicines, especially blood thinners and anti-inflammatory painkillers, and any other health problems.
- If you smoke or drink heavily, mention this, as it affects healing and recovery.
What happens
The operation is done under general anaesthetic, urgently. The surgeon enters the abdomen, either through small keyhole cuts or a single larger cut, finds the perforation, and closes it. Most often a piece of omentum is stitched over the hole to seal it.
The abdomen is then washed out thoroughly to remove leaked stomach contents and reduce the infection. A drain may be left in place to let any remaining fluid escape, and the stomach tube usually stays in for a short time afterwards.
The operation typically takes around one to two hours, but this varies with how much contamination there is and what the surgeon finds. Afterwards you recover in a high-dependency or ward setting, sometimes intensive care if you were very unwell, with fluids, antibiotics and pain relief.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Surgery is almost always needed; non-surgical management is only considered in carefully selected, stable patients under close monitoring.
- Delay is not safe — putting off surgery in a confirmed perforation raises the risk of death.
- Keyhole surgery may not be suitable when someone is very unwell or the findings are complex.
- Decisions in a frail or very unwell person should weigh the benefits and burdens, sometimes with the family, including ceilings of treatment.
Delay surgery if…
- This is an emergency — treatment is not usually delayed, but resuscitation with fluids and antibiotics happens first and fast.
- Diagnosis is confirmed quickly with examination and a scan before theatre.
- Blood thinners are accounted for as part of urgent planning, not as a reason to wait long.
- Any delay should be minimised, as outcomes worsen the longer surgery is postponed.
Alternatives to discuss
- Carefully selected non-surgical (conservative) management in stable patients, with close monitoring.
- More extensive surgery (such as removing part of the stomach) if a simple patch is not possible.
- Comfort-focused care in a very frail patient where surgery would not be in their best interests.
- After recovery, medical treatment of the ulcer cause to prevent recurrence.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Closes the leak and stops stomach contents spilling into the abdomen
- Treats the life-threatening infection (peritonitis)
- Is often the only effective treatment for a perforated ulcer
- Allows the underlying ulcer cause to be treated afterwards
- Gives the best chance of recovery from a serious emergency
Risks & complications
- Pain from the wound or keyhole sites
- Tiredness and a slow return of appetite and bowel function
- A temporary tube in the stomach and a drip while the gut recovers
- A period of feeling weak, needing weeks to build up
- Wound or chest infection
- A collection of infected fluid (abscess) inside the abdomen
- Slow recovery of bowel function (ileus)
- Blood clots in the legs or lungs
- The repair leaking, sometimes needing further surgery
- Bleeding needing further treatment
- Severe infection leading to organ problems
- A complication serious enough to be life-threatening
A perforated ulcer is a serious emergency, and the operation carries real risk — overall death rates after this kind of emergency surgery are not low, and are higher with older age, shock at the time of surgery, other illnesses and delay in getting to theatre. This means speed matters: sudden severe tummy pain should be treated as an emergency. The team will explain your individual risk as far as they can in the circumstances.
Published figures to discuss
This is emergency surgery in people who are often already very unwell, so risk is meaningfully higher than for planned operations. Outcomes depend strongly on age, shock at presentation, other illnesses and how quickly surgery happens. The figures below are cautious and from UK and international data; they describe groups, not any one person.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Death after emergency repair | Commonly reported around 10–25% overall, and higher in older or very unwell patients | Strongly affected by age, shock at presentation, other illnesses and delay to surgery; WSES guidance reports high mortality in perforated ulcer cohorts. | WSES guidelines — perforated and bleeding peptic ulcer (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Failure of the repair (leak) | About 4–6% in common repair series, and up to about 12% reported for large/giant ulcers | May need further surgery; risk rises with a larger hole, friable tissue, shock, sepsis and delayed presentation. | WSES guidelines — perforated and bleeding peptic ulcer (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Wound or abdominal infection | No reliable single percentage; infection is part of the substantial morbidity of perforated-ulcer peritonitis | The operation starts from contamination rather than a clean wound. Washout, source control and antibiotics reduce, but do not remove, this risk. | WSES guidelines — perforated and bleeding peptic ulcer (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is from major emergency surgery and from a serious infection, so it takes time. The early days are spent in hospital while the gut recovers and infection is treated; full recovery usually takes several weeks or longer.
- Feeling weak and tired for several weeks after a serious illness and operation
- A slow return of appetite and normal bowel habit
- Wound discomfort that eases over the first weeks
- Needing acid-lowering medicines for a period afterwards
Aftercare
- Take acid-lowering medicines exactly as prescribed to help the ulcer heal.
- Complete any treatment for Helicobacter pylori and have a test to confirm it has cleared.
- Avoid anti-inflammatory painkillers (such as ibuprofen) unless your doctor says they are safe.
- Stop smoking and limit alcohol, both of which slow ulcer healing.
- Build up activity gradually and follow advice on lifting and returning to work.
- Keep wounds clean, watch for signs of infection, and attend follow-up appointments.
- Acid-lowering medicines understood and supplied
- Plan for Helicobacter pylori testing and treatment
- List of painkillers to avoid
- Support at home for the first weeks
- Follow-up and any repeat gastroscopy booked
- Out-of-hours number saved for warning signs
Scars and how they heal
Keyhole surgery leaves a few small scars on the tummy; open surgery leaves a longer scar down or across the abdomen. Scars fade over months. An emergency wound can sometimes be slower to heal, especially if there was heavy infection.
⚠ Get urgent help if…
- Severe or worsening tummy pain after surgery
- A high temperature, shivering or feeling very unwell (a possible sign of infection or a leak)
- A fast heartbeat, breathlessness or chest pain
- A swollen, hot or painful calf
- Persistent vomiting, or being unable to keep fluids down
- A wound that opens, becomes hot and red, or leaks fluid
- Vomiting blood or passing black, tarry stools
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A successful operation seals the hole and controls the infection, giving the best chance of recovery. How well someone does depends heavily on their age, other health problems, and how quickly they reached surgery, rather than on the technique alone.
Closing the perforation deals with the emergency, but it does not by itself cure the ulcer. Treating the underlying cause — usually Helicobacter pylori infection or anti-inflammatory painkillers — and using acid-lowering medicines are what give the ulcer the chance to heal and reduce the risk of it happening again.
Once the perforation is repaired and the underlying cause treated, ulcers often heal well. The risk of another ulcer is much lower if Helicobacter pylori is cleared and ulcer-provoking painkillers are avoided. Continuing to smoke, drink heavily or take anti-inflammatory drugs raises the risk of recurrence. For stomach ulcers, a follow-up camera test is sometimes advised to confirm healing.
Combining with other procedures
Surgery is the emergency part of treatment, but it sits alongside medical care: antibiotics, acid-lowering medicines, and testing for and treating Helicobacter pylori. A gastroscopy is often arranged afterwards, particularly for gastric ulcers, to confirm healing and rule out other causes.
Follow-up & long-term care
Follow-up confirms that the ulcer cause has been treated and, where advised, that the ulcer has healed. You should have a clear plan for acid-lowering medicines, Helicobacter pylori testing, and which painkillers to avoid. Report severe pain, fever or vomiting urgently rather than waiting for a routine appointment.
- Finish and confirm Helicobacter pylori treatment if you needed it.
- Continue acid-lowering medicines for as long as advised.
- Avoid anti-inflammatory painkillers unless your doctor agrees they are safe.
- Stop smoking and limit alcohol to lower the risk of another ulcer.
- Attend any recommended follow-up gastroscopy.
Revision and secondary surgery reality
- If the repair leaks or an abscess forms, further surgery or drainage may be needed.
- Occasionally a larger operation is required if a simple patch will not hold.
- A follow-up gastroscopy is sometimes advised, especially for gastric ulcers, to confirm healing.
- Ongoing medical treatment is needed to heal the ulcer and prevent recurrence.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Close monitoring after surgery, with escalation to higher-level care if needed.
- A clear plan for acid-lowering medicines and Helicobacter pylori testing and treatment.
- Written advice on painkillers to avoid and warning signs to act on.
- Follow-up to confirm recovery and, where advised, ulcer healing on gastroscopy.
- Support at home during a recovery that often takes several weeks.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- As an emergency operation it is provided by the NHS; private cost questions rarely apply
- Whether surgery is keyhole or open, and the operating time
- Length of hospital stay, including any intensive or high-dependency care
- Surgeon and anaesthetist involvement
- Scans and tests to diagnose and plan surgery
- After-care including medicines, Helicobacter pylori treatment and follow-up
- Management of any complications
- As an emergency, this is NHS-provided; a private quote would rarely apply
- If ever costed privately: surgeon, anaesthetist and facility fees
- Length of stay, including critical care
- Diagnostic scans and tests
- Follow-up, medicines and any repeat gastroscopy
- What happens, and what it costs, if a complication occurs
- Who provides emergency cover if you become unwell again
On the NHS? This is an emergency operation provided by the NHS; it is not an elective or privately arranged procedure, so cost factors are included for completeness only.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- In an emergency, consent may have to be brief or taken from next of kin — but the seriousness and main risks should still be conveyed.
- Not explaining that surgery treats the emergency, while medicines and Helicobacter pylori treatment heal the ulcer.
- Not advising which painkillers to avoid afterwards.
- No clear plan for follow-up or, for gastric ulcers, a check that the ulcer has healed.
- Not discussing realistic risk given age and other illnesses.
Marketing red flags
- This is emergency, not elective, surgery, so marketing claims should not arise — be wary of any private service framing it as routine.
- Any suggestion that recovery is quick or low-risk for an acutely unwell patient.
- Downplaying the importance of treating the underlying ulcer cause.
- Promising a guaranteed outcome from emergency surgery.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What did you find, and how was the hole closed?
- Was my surgery keyhole or open, and why?
- Do I need treatment for Helicobacter pylori, and how will it be confirmed as cleared?
- Which painkillers should I avoid from now on?
- Will I need a repeat camera test to check the ulcer has healed?
- What warning signs after going home mean I should seek urgent help?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is this an emergency operation?
Can a perforated ulcer be treated without surgery?
Will the ulcer come back?
Keyhole or open surgery — which is better?
How long is the recovery?
Why do I need treatment for a stomach bug afterwards?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Patient.info (professional) — Ulcer surgery and its complications RCS England (Annals, 2024) — Laparoscopic vs open repair of perforated peptic ulcer Laparoscopic surgery for perforated peptic ulcer — English national cohort WSES guidelines — perforated and bleeding peptic ulcer Perforated peptic ulcer — an update (World J Gastrointest Surg) WSES guidelines — perforated and bleeding peptic ulcer (PMC) WSES guidelines — perforated and bleeding peptic ulcer (PubMed) NICE CG184 — Gastro-oesophageal reflux disease and dyspepsia in adults (peptic ulcer, H. pylori eradication, NSAID advice; 2014, updated 2019)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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