**Core Concept**
In the treatment of a perforated peptic ulcer, the primary goal is to repair the perforation, address any associated bleeding, and prevent further complications such as peritonitis. A range of surgical techniques can be employed, including omental patch repair, highly selective vagotomy, and H. pylori eradication.

**Why the Correct Answer is Right**
Under running of vessel is not a suitable technique for treating a perforated peptic ulcer because it does not directly address the perforation itself. Instead, it involves ligating the bleeding vessel, which may not be the primary concern in an acute perforation scenario. The correct approach involves repairing the perforation using a technique such as omental patch repair or highly selective vagotomy, while also addressing any associated bleeding.

**Why Each Wrong Option is Incorrect**
**Option B:** While H. pylori eradication is an essential component of managing peptic ulcer disease, it is not a direct treatment for a perforated peptic ulcer and is typically performed after the acute situation has been managed.

**Option C:** Highly selective vagotomy can be an effective treatment for peptic ulcer disease, particularly for patients with a high risk of recurrence. It involves selective denervation of the stomach to reduce acid production.

**Option D:** Omental patch repair is a common technique used to repair perforated peptic ulcers. It involves covering the perforation with a piece of omentum, which helps to contain the perforation and promote healing.

**Clinical Pearl / High-Yield Fact**
In the treatment of perforated peptic ulcers, it is essential to address the perforation promptly to prevent peritonitis and other complications. A combination of surgical repair and H. pylori eradication is typically employed to manage the condition effectively.

**✓ Correct Answer:** A. Under running of vessel