CLOSURE OF PEPTIC ULCER PERFORATION BY GRAHM'S PATCH WITH OMENTOPEXY VERSUS PLUGGING WITH OMENTOPEXY

Abstract

Background: Duodenal and Gastric perforations are one of the most common causes of peritonitis and lead to major postoperative complications. If these post-operative complications are reduced, that can lead to an improvement in morbidity and mortality. In Perforation because of peptic ulcer, different modalities of treatment varies from conservative management, simple closure of ulcer, ulcer closure with omentum, jejunal serosal patch, definitive treatment with truncal vagotomy and drainage procedures or parietal cell vagotomy, laparoscopic repair and NOTES omental repair. Methods: The study was conducted in 60 patients of peptic ulcer perforation. Out of these 60 patients: 30 patients (group A) underwent Grahm’s patch repair with omentopexy, and other 30 patients (group B) underwent omental plugging with omentopexy, and this procedure is different from modified Grahm’s patch. The outcome of procedures was done in term of complication like bile leakage, wound infection, respiratory infection, intra-abdominal abscess, burst abdomen/ gastric outlet obstruction and mortality. Results: Peptic ulcer perforation shows male predominance over female. Was vividly demonstrated by incidence of 25 males (83.33%) and 5(16.66%) female in group A where as in Group B incidence of disease was 24 males (80.0%) and 6 (20.0%) were females. No statistical difference between two groups. Mean age in group A was 46.80 ± 13.9 years and group B was 48.60 ± 14.04 years. Biliary leak was seen in 4 cases of Grahm’s patch with omentopexy whereas no leak was seen in omental plugging with omentopexy. Wound infection and mortality were also significantly high in Grahm’s patch group in comparison to omental plugging with omentopexy. Conclusion: Analysis of results of present study showed that omental plugging with omentopexy has tremendous scope over Grahm’s patch with omentopexy in terms of morbidity and mortality.