Modified Grahams′ omentopexy in acute perforation of first part of duodenum; A tertiary level experience in South India

Satapathy, Mani Charan; Dash, Dharitri; Panda, Charan

doi:10.4103/2320-3846.125032

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…The use of vascularised pedicled omentum helps in sealing the perforation and reduces the risk of cutting through of sutures used for perforation closure; neovascularisation accelerates ulcer healing and prevents recurrence. 12 Minimum invasive treatment or laparoscopic closure of peptic perforation is gaining popularity because of less pain, decreased morbidity and reduced hospital stay. But this takes more operative time and trained personnel are not available everywhere; so laparoscopic surgery repair of perforated peptic ulcer yet is not the procedure of choice in majority of hospitals.…”

Section: Discussionmentioning

confidence: 99%

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

Arora

2017

Int Surg J

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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.

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Section: Discussionmentioning

confidence: 99%

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

Arora

2017

Int Surg J

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“…This nigerian study concluded that in their region there are more cases of gastric perforation than duodenal ones but in our study perforations of duodenum are found to be common. 13,14 There is a great deal of racial and geographical variations in incidence of perforated peptic ulcer. 15 Though, in the west its prevalence has decreased but still there is high mortality rate of the disease in Japan and United States but in our study mortality rate is somewhat decreased.…”

Section: Discussionmentioning

confidence: 99%

Perforated Peptic Ulcer Disease;

Jamali

Ghumro

Zardari

et al. 2019

TPMJ

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Introduction: Peptic ulcer perforation is the most common surgical emergency and the leading cause of peritonitis with high morbidity and mortality in all age groups throughout world. It is more prevalent in developing countries than developed ones. Graham’s Patch/omentopexy for duodenal perforation and simple closure along with tissue biopsy for the gastric perforation are the procedures of choice respectively. Objectives: To detect the mode of presentation and the outcomes of surgical procedures along with prognosis in patients suffering from perforated peptic ulcer. Study Design: Cross sectional study. Place and Duration of Study: Surgical Department of Peoples University of Medical & Health Science for Women Nawabshah, From January 2016 to December 2017. Methodology: All patients were admitted through OPD/Emergency. Patients presented with peritonitis having history of peptic ulcer disease were studied. X Ray chest/ X Ray abdomen Erect showed pnemoperitonium. Laparotomy and primary repair along with biopsy for gastric perforation and graham’s patch for duodenal perforations were performed. Results: In our study, total 52 patients were included. Male Female ratio was 3.5:1.6. Mean age was 49 years. Majority of patients presented in 5th to 6th decade of their life. In 96% cases abdominal pain was the 1st symptom followed by vomiting and distension of abdomen. Different surgical procedures were performed and surgical site infection was the commonest complication in 37 (73%) patients in our study. Conclusion: Primary closure and graham’s patch are the best choice as surgical procedures for the cases of gastric and duodenal ulcer perforations respectively.

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“…While, definitive ulcer surgery with closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy is a better technique in young patients having no comorbid condition who presented early without signs of shock. Using vascularized pedicled omentum could help in sealing the perforation and neo-vascularization could accelerate healing of the ulcer and decrease incidence of recurrence [12]. The role of definitive surgery of perforated peptic has markedly declined due to advancement of medical therapy for eradication of H. pylori infection which resulted in a lower incidence of peptic ulcer disease and perforation.…”

Section: Discussionmentioning

confidence: 99%