Modified Graham’s repair for peptic ulcer perforation: reassessment study

Abstract

Background: Peptic perforation is an emergency and requires urgent surgical treatment. Many modalities of treatment are available ranging from conservative treatment to laparoscopic repair. There is no consensus on treatment of perforated pylorodudenal ulcer which can be treated with conservative treatment, simple closure of ulcer, closure of ulcer with free omentum, closure of perforation with use of pedicled omentum, definitive treatment with truncal vagotomy and drainage procedures or parietal cell vagotomy. However best treatment is still to be decided.Methods: This study was conducted in department of surgery 60 patients presenting with peptic perforation in last three years. All patients with duodenal perforation in first part (D1) were included in the study. Pyloric perforations, multiple perforations, traumatic perforations and severe co-morbid condition were excluded from study. A pedicled omentum was used in the repair of duodenal perforation. Immediate and late postoperative complications were recorded. The patients were followed for three months.Results: Out of 60 cases there were 50 male patients and 10 female patients. The majority of male patients were in the middle age group between 35 to 45 years of age and the female patients were of older age group between 40 to 65 years of age. These patients presented with history of acute pain abdomen in the epigastric region. All the patients underwent modified Graham’s patch repair. In postoperative period, two patients had burst abdomen on fourth postoperative day. Biliary fistula formation occurred in 2 patients. Wound infection occurred in 4 patients and the hospital stay was 5 to 9 days. There was no mortality recorded in this series.Conclusions: In summary, the surgery for perforated peptic ulcer should use modified Graham’s repair using pedicled omentum giving excellent results in terms of healing, morbidity and mortality.

Study of Perforation Peritonitis at a Tertiary Center of Northern Tribal Belt of Chhattisgarh

“…Higher frequency in males was also observed in similar studies done on perforation peritonitis. 6,7,8 The common encountered age group between 41-50 years in some studies, is also observed in case of females in the present study. 9,10 Perforation was found to be common in males between 35-45 yrs.…”

“…of age group and in case of females older age group between 40 to 65 years is observed in a study which is quite similar to the present study. 6 In our study majority cases were associated with positive history of acid peptic disease 69.4%, other risk factors included were tobacco chewing & smoking in 37%, alcohol in 25%, drug abuse in 18.5% cases (Table-2). 60 cases of perforation peritonitis reported in a study show positive history of smoking and alcoholics with occasional use of NSAIDs in 43 males while 8 female were associated with using only NSAIDs and 9 cases were not found to be associated with risk factors 6 .…”

A rare case of spontaneous gastric perforation in an adolescent

“…[6][7][8] Surgical management remains the corner stone in perforated ulcers. [9][10][11] Traditional open surgical method is usually undertaken. Simple closure with or without Omentum is one of the most commonly used technique.…”

“…Simple closure with or without Omentum is one of the most commonly used technique. 10 Time should not be wasted after clinical diagnosis for surgery as it can lead to adverse results. In children partial gastrectomy is seldom advised even though in adults for large perforations it is being carried out.…”

“…stay of treatment. 10,11 Minimal invasive approach is fast becoming popular even in emergency settings. 12…”