{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:31:23Z","timestamp":1792290683543,"version":"4.4.0"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Objective: Intraoperative biopsy in perforated gastric ulcers has traditionally been widely used to exclude the risk of malignancy. However, despite accumulating evidence in recent years indicating a low incidence of malignancy, it remains unclear to what extent this approach has been adopted by surgeons. This study aims to evaluate the attitudes of general surgeons in T\u00fcrkiye toward intraoperative biopsy in perforated gastric ulcers and to identify the factors influencing this decision. Materials and Methods: A descriptive, cross-sectional, nationwide survey was conducted among actively practicing general surgeons in T\u00fcrkiye. A total of 361 surgeons were included. The structured questionnaire addressed demographic data, biopsy practices in perforated gastric ulcers, preferred surgical approaches, and postoperative endoscopy planning. Multivariable logistic regression analysis was performed to determine factors associated with routine intraoperative biopsy. Results: The mean age of participants was 41.4 \u00b1 10.3 years, and the mean duration of surgical experience was 12.8 \u00b1 9.7 years. Only 34.07% of surgeons correctly estimated the current malignancy risk (&lt;5%) in perforated gastric ulcers; 115 participants (28.3%) did not provide a quantitative estimate. Among respondents, 54.57% reported performing routine intraoperative biopsy, 41.55% reported performing selective biopsy, and 3.88% reported performing no biopsy. Surgeons performing routine biopsy were older (42.6 \u00b1 10.1 vs. 39.8 \u00b1 10.1 years, p = 0.01) and more experienced (14.3 \u00b1 9.7 vs. 11.0 \u00b1 9.2 years, p = 0.002). In multivariable logistic regression, age (OR 1.02, 95% CI 0.95\u20131.10, p = 0.608), surgical experience (OR 1.01, 95% CI 0.93\u20131.09, p = 0.820), and perceived malignancy risk (OR 1.02, 95% CI 0.99\u20131.05, p = 0.116) were not independent predictors of routine biopsy. Postoperative endoscopy was recommended by 87.53% of participants. Conclusions: Routine intraoperative biopsy for perforated gastric ulcers remains widely practiced in T\u00fcrkiye despite the low malignancy rates reported in the contemporary literature. Surgeons\u2019 biopsy decisions are largely influenced by perceived malignancy risk, experience, and traditional clinical approaches. These findings suggest that an evidence-based strategy relying on selective biopsy and planned postoperative endoscopy, rather than routine intraoperative biopsy, should be more effectively integrated into clinical practice.<\/jats:p>","DOI":"10.3390\/healthcare14101323","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T12:46:55Z","timestamp":1778676415000},"page":"1323","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgeons\u2019 Perspectives on Intraoperative Biopsy in Perforated Gastric Ulcers: A Nationwide Survey from T\u00fcrkiye"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5381-513X","authenticated-orcid":false,"given":"Adem","family":"Tuncer","sequence":"first","affiliation":[{"name":"Department of General Surgery, Florence Nightingale Hospital, Demiro\u011flu Bilim University, Istanbul 34365, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuneyt","family":"Kayaalp","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Istanbul Atlas University, Istanbul 34403, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Servet","family":"Karagul","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Istanbul Atlas University, Istanbul 34403, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0140-6736(16)32404-7","article-title":"Peptic ulcer disease","volume":"390","author":"Lanas","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/S0140-6736(15)00276-7","article-title":"Perforated peptic ulcer","volume":"386","author":"Thorsen","year":"2015","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1159\/000323958","article-title":"Systematic review of the epidemiology of complicated peptic ulcer disease: Incidence, recurrence, risk factors and mortality","volume":"84","author":"Lau","year":"2011","journal-title":"Digestion"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1002\/bjs.9175","article-title":"Surgical delay is a critical determinant of survival in perforated peptic ulcer","volume":"100","author":"Buck","year":"2013","journal-title":"Br. 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