Omental Patch Research Articles

098. Report in Emergency repair for Duodenum Part 1 Perforation in Referral Hospital Banyumas

Introduction: Duodenal perforation was frequent cause of hollow viscus perforation beside to gastric perforation. Immediate source control properties, reproducibility, simplicity and applicability was the prefer method in emergency setting to repair this perforation. Case: We present one case of female, 46 years old patient with duodenal part 1 perforation with Boey Score 1, where we performed repair with primary suturing, gastrojejunal – braun anastomosis and omental patch. We found part 1 duodenal perforation 1.5cm in diameter. Patient was in hospital for 5 days before being discharged. Conclusions: Primary suturing, gastrojejunal – braun anastomosis and omental patch applicable in referral hospital, were preferable method that has best result and easy repair technique based on this report.

030. Delayed Presentation of Blunt Traumatic Diaphragmatic Hernia 15 Years After Injury: A Case Report

Background: Traumatic diaphragmatic rupture is rare with incidence between 0.8-8% and often resulting from blunt or penetrating trauma. We present a case of delayed diaphragmatic hernia in a 41-year-old male, 15 years after blunt abdominal trauma. Case: A 41-year-old male presented with dyspnea and severe abdominal pain. He reported being struck in the abdomen with wood during a gang attack 15 years prior. A year after the accident, he complained of uncomfortable breathing that worsened in the past 6 years. Physical examination revealed decreased breath sounds on the left side and a distended abdomen. Imaging confirmed bowel herniation into the left hemithorax, partial lung collapse, and a mediastinal shift. Emergency laparotomy revealed a 5 cm diaphragmatic defect, massive gastric necrosis, and herniation of abdominal organs into the thoracic cavity. The defect was closed with primary repair, and necrotic gastric tissue was excised and repaired using primary closure with omental patch. The patient recovered well and was discharged on day 11. Conclusion: Diaphragmatic ruptures require prompt surgical repair to prevent complications. Physicians must carefully evaluate trauma history and conduct thorough examinations to improve outcomes in emergency settings.

ThP3.4 - Suture Endoclips coding, a novel technique to improve efficiency and reduce errors In laparoscopic repair of peptic ulcer perforation

Abstract The presentation describes our a novel technique of using Endo clips to tag the sutures during laparoscopic repair of perforated peptic ulcer utilizing Graham omental patch, Methods Four patients presented with perforated peptic ulcer. All treated with Laparoscopically. Supine position with split leg was standard. 5 and10mm thirty-degree scopes were used to facilitate efficient and comprehensive washing, through 11 mm umbilical port and two 5 mm ports. An extra 5mm port was needed on the lateral right Upper Quadrant for drain or liver retractor. We used 5mm endoclips to tag the end of sutures and create a tunnel to pass the patch through it. Each suture end was tagged with either one, two or three clips, in order. The suture ends were held together to create a tunnel, where the omental patch was passed through that tunnel. Corresponding sutures end where identified easily by holding endoclips in order, then removed to allow the two ends to be tied without mixing the sutures. Furthermore, the endoclip tagging prevents suture looping around each other, minimizing wasted time, error and dislodging the stitches during identifying, correcting the looping and picking the corresponding ends. All patients had uneventful recovery, with assuring follow up. Conclusions Our novel technique of suture Coding with endolcips eliminated the confusion between the different suture threads and prevents looping and consequently improved the technique efficiency and prevent mistakes and loose ties

Perforated duodenal ulcer after Roux-en-Y gastric bypass: an unusual complication.

Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis. The pathophysiology of this perforation is not clear, but several mechanisms have been proposed. Helicobacter pylori has been implicated. Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.

Marginal Ulcer Perforation after One Anastomosis Gastric Bypass: Surgical Treatment and Two-Year Outcomes.

Background: Marginal ulcer (MU) perforation is a chronic complication after One-anastomosis Gastric Bypass (OAGB). This study's purpose was to analyze patients undergoing OAGB revision due to MU perforation and describe the two-year outcomes. Methods: A retrospective analysis of a database in a single-tertiary hospital. All patients undergoing surgical revision due to MU perforation were included. Results: During the study period, 22 patients underwent OAGB revision due to MU perforation. The rate of MU perforation was 0.98%. The median age was 48 years and there were 13 men (59%). The median time from OAGB to MU perforation was 19 months with a median total weight loss of 31.5%. Nine patients (41%) were smokers. Omental patch (±primary closure) was performed in 19 patients (86%) and three patients (14%) underwent conversion to Roux-en-Y gastric bypass (RYGB). At a median follow-up of 48 months, three patients (14%) had recurrent MU diagnosis, of which one had a recurrent MU perforation. Four patients (18%) underwent conversion to RYGB during follow-up. Conclusions: MU perforation is a chronic complication after OAGB. In this cohort, most patients were men and likely to be smokers. Omental patch was effective in most cases. Recurrent MU rates at two years follow-up were acceptable.

Use of jejunal serosal patch and pyloric exclusion in the management of complex duodenal injury.

Duodenal injuries are relatively rare but remain a management challenge with a high incidence of postoperative complications. Guidelines from the World Society of Emergency Surgery and American Association for the Surgery of Trauma favour a primary repair for less-complex injuries, but the management of more complex duodenal trauma remains controversial with varying techniques supported, including pyloric exclusion, omental or jejunal patch closure, gastrojejunostomy and pancreatoduodenectomy. We describe the techniques used in one case of complex duodenal trauma. The duodenum is approached via a standard laparotomy with Kocherisation. Primary repair of the duodenal perforations is performed using a 3/0 polydioxanone suture (PDS), followed by mobilisation of a loop of mid-jejunum against the area of duodenal trauma over the primary repair as a jejunal serosal patch. The antimesenteric jejunal serosal border is sutured to the serosa of the duodenum (serosa only) using a 3/0 PDS. Pyloric exclusion is then performed through an anterior gastrostomy, to control the volume of gastric juice entering the duodenum. The pylorus is sutured closed using an absorbable suture followed by closure of the anterior gastrostomy using a GIA stapling device.

Duodenal Diverticulum Perforation: A Rare Case Report and Review of the Literature

Aim: Duodenal diverticulum is the second most common diverticulum section in the gastrointestinal system, but perforation is rare. It is frequently diagnosed incidentally and has little clinical evidence. There are no certain treatment strategies for duodenal diverticulum perforation. Our aim is to identify perforated duodenal diverticulum cases published in the last 10 years through our case report and to evaluate different approaches to treatment. Case Report: A 58-year-old male was diagnosed central nervous system (CNS) tumor with a perforated duodenal diverticulum. Our case presented with abdominal pain and pneumoperitoneum on imaging. The patient was treated surgically with an omental patch, pyloric exclusion, retrocolic gastrojejunostomy, and tube duodenostomy. The patient died on the 10th postoperative day. Conclusion: Duodenal diverticulum perforation is a rare but fatal condition. CT is useful in diagnosis. If the patient is not in a septic condition, it can be followed conservatively. However, if the patient is in a septic condition, surgery may be required. Surgical options should be determined based on the perforation site and characteristics.

What is Valentino's syndrome?

AbstractThe eponym ‘Valentino's syndrome’ is used to describe patients with perforated peptic ulcer disease who present with right lower quadrant pain and suspected appendicitis. It is named for Rudolph Valentino, the film star who died on 23 August 1926 at the age of 31 from complications of perforated peptic ulcer disease. In the early 1920s, the Italian‐born actor had a meteoric rise to fame in the burgeoning film industry. His first starring role in the 1921 silent film, The Four Horseman of the Apocalypse, was a sensation and was followed quickly by a string of commercially successful movies. He was in good health until he presented with an acute abdomen in early August of 1926. He underwent a laparotomy and was found to have a perforated peptic ulcer that was repaired with simple closure and an omental patch. He initially rallied after surgery but ultimately died on the eighth post‐operative day from complications of sepsis. This manuscript will review Valentino's brief acting career, his medical history, and how the eponym which bears his name describes a disease presentation that is different from his actual clinical course.

Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study.

Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting. This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses. Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs. Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.

Conventional versus enhanced recovery after surgery protocols in emergency gastrointestinal tract surgery: a randomized clinical trial

Background Compared with elective operations, emergency abdominal surgery is more likely to result in perioperative morbidity and mortality. Implementation of care programs could be beneficial for such patients to decrease complication rates. Enhanced recovery after surgery (ERAS) is a complex perioperative approach that has proven its efficacy in multiple elective procedures. Nonetheless, its efficacy in emergency abdominal surgery has been questioned. Herein, we compared the ERAS and conventional approaches in the management of such patients. Patients and methods Sixty adult patients were enrolled in our randomized prospective trial, and they were assigned to two groups; the conventional and ERAS groups. The duration of hospitalization was the main outcome. Results Preoperative characteristics, presentation, and surgical operations were comparable between the two study groups. A perforated duodenal ulcer was the most common diagnosis and was treated by through and through suture with the omental patch (36%) followed by resection anastomosis (36%) in patients with ischemic loop or patients with severely injured loops, and primary repair in simple injury (28%). The hospitalization period decreased significantly in ERAS patients (5.9 vs. 10.5 days in the conventional group P&lt;0.001). The ERAS protocol had a significant beneficial impact on postoperative recovery, which manifested in earlier nasogastric tube removal, drain removal, bowel sounds, bowel motion, and oral intake compared with the conventional group. The incidence of postoperative complications especially surgical site infection increased significantly with the conventional perioperative regimen (36.7% vs. 13.3% after ERAS P=0.034). Conclusion ERAS has multiple advantages over the conventional approach when implemented in emergency surgery patients and is recommended in emergency surgical practice.

Novel Technique for The Placement of Omental Patch During Repair of Perforated Duodenal Ulcer. A Retrospective Study of Prospectively Collected Data

Novel Technique for The Placement of Omental Patch During Repair of Perforated Duodenal Ulcer. A Retrospective Study of Prospectively Collected Data

Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital.

Perforated peptic ulcer (PPU) is associated with significant morbidity and mortality, particularly in low to middle income countries. This study aimed to scrutinise the clinical course of patients diagnosed with PPU and identify modifiable factors to improve outcomes. A retrospective review of the hybrid electronic medical record (HEMR) database at Grey's Hospital was performed. All patients diagnosed with PPU between January 2013 and December 2020 were entered into the study. The variables collected include age, ethnicity, comorbid profile, Boey score, type of surgery performed and complications. These factors were analysed to determine the factors responsible for morbidity and mortality. One hundred and ninety four patients were diagnosed with PPU during the study period. Six patients were treated non-operatively, all of whom survived. In the surgically treated group, omental patch repair was performed in 159 (84.5%) patients, and primary closure in 26 (13.8%) patients. The leak rate was 32% in the cohort that underwent relaparotomy and the overall mortality was 14%. There was no significant relationship between the type of repair performed and outcome. All patients had a Boey score of 1 or more. The following factors were found to increase the probability of in-hospital mortality: age > 40 years (OR: 8.49, 95% CI 2.46-29.29 p < 0.01), female gender (OR: 2.509, CI 0.98-6.37, p = 0.048), need for relaparotomy (OR: 0.398, CI 0.17-0.91, p = 0.027) and Boey score > 1 (OR: 46.437, CI 6.13-350.28, p < 0.01). A Boey score > 1 was the only variable that increased the likelihood of finding a leaking repair at relaparotomy (p < 0.01). The Boey score was a significant predictor of mortality and leak rate in our patients with PPU. Adding age as a variable may improve the ability to predict mortality in our setting, while the impact of gender and ethnicity needs further investigation.

Successful treatment of esophageal perforation due to black esophagus (acute esophageal necrosis): a case report

BackgroundBlack esophagus, or acute esophageal necrosis (AEN), is a rare disease with a poor prognosis in which the esophageal mucosa is black in color. We report a case of esophageal perforation due to AEN that was successfully treated.Case presentationAn 88-year-old woman presented to her local hospital with the chief complaint of abdominal pain. Endoscopic and radiological examinations revealed esophageal perforation due to AEN and duodenal perforation. Omental patch repair was performed for the esophageal perforation, and the duodenal ulcer perforation was treated by simple closure and gastrojejunostomy at the local hospital. Following refractory esophageal and duodenal perforations after the initial surgery, the patient was transferred to our hospital where emergent surgery was performed, comprising thoracoscopic esophagectomy, cervical esophagostomy, T-tube drainage, and omentopexy for duodenal perforation, as well as thoracic and abdominal drainage. Mucosal regeneration of the esophagostomy was confirmed endoscopically on postoperative day 19.ConclusionsAppropriate surgical intervention may be an optimal option in patients with esophageal perforation due to AEN.

Perforated Marginal Ulcer, Post Roux-En-Y Surgery without Risk Factors: A Case Report

A marginal ulcer is a commonly occurring complication of Roux-en-Y gastric bypass, with an occurrence rate of up to 16%. However, perforation of such ulcers is rare, affecting approximately 1% of cases and typically manifesting at a later stage. Moreover, risk factors, whether surgical or non-surgical, are present in nearly all patients reported in the literature, with only 0.2% found to have none. This case report focuses on a 32-year-old female patient who presented with severe left-sided abdominal pain. She had a history of undergoing Roux-en-Y surgery two years prior. A CT scan of the abdomen revealed the presence of free air and contrast leak, indicative of a perforated marginal ulcer. The patient subsequently underwent a laparoscopic repair of the marginal ulcer, involving the use of an omental patch. In patients experiencing recurrent abdominal pain, the suspicion of a marginal ulcer should arise, prompting the inclusion of upper endoscopy as part of the diagnostic workup. The feasibility of laparoscopic repair with an omental patch has been demonstrated, and patients are advised to undergo follow-up endoscopy. Doctors should have a high suspicion index for perforation of marginal ulcer with any patient after bariatric surgery despite the absence of risk factors.

Retrospective comparison of outcomes of patients undergoing omental patch versus falciform patch repair of perforated peptic ulcers.

The omental patch repair is the gold standard for the repair of perforated peptic ulcers. This can be performed open or laparoscopically. However, in the event of non-viable or inadequate omentum available at the time of surgery the falciform ligament has been reportedly used to as an alternative. Nonetheless, evidence for its safety is scant. This study aims to determine differences in patient outcomes when comparing the two repair techniques. Following ethics approval, patients who underwent surgical repair of perforated peptic ulcers using omental or falciform patch repair, between 1 January 2010 and 31 December 2017, across all three Western Australian tertiary hospital services and at least 18 years of age were included. Data were collected by reviewing medical records of included patients. Three hundred twenty-nine patients who underwent either open or laparoscopic repairs were included. Thirty-seven patients had falciform repairs and were mostly ASA of 2 compared to 292 patients receiving omental patch repair who were mostly ASA 3. Falciform patch repairs were more commonly used in duodenal ulcer perforations. There were no statistically significant differences in patient outcomes between the omental patch and falciform ligament groups. This included post-operative intra-abdominal sepsis, return to theatre, post-operative ICU admission, inpatient mortality, 30-day readmission and ulcer healing on follow-up gastroscopy. This study demonstrates safety, efficacy and similar outcomes for patients receiving the falciform ligament patch repair compared with omental patch repair.

Experience of management of pediatric upper gastrointestinal perforations: a series of 30 cases.

This study aimed to explore the characteristics of pediatric upper gastrointestinal (UGI) perforations, focusing on their diagnosis and management. Between January 2013 and December 2021, 30 children with confirmed UGI perforations were enrolled, and their clinical data were analyzed. Two groups were compared according to management options, including open surgical repair (OSR) and laparoscopic/gastroscopic repair (LR). A total of 30 patients with a median age of 36.0 months (1 day-17 years) were included in the study. There were 19 and 11 patients in the LR and OSR groups, respectively. In the LR group, two patients were treated via exploratory laparoscopy and OSR, and the other patients were managed via gastroscopic repair. Ten and three patients presented the duration from symptom onset to diagnosis within 24 h (p = 0.177) and the number of patients with hemodynamically unstable perforations was 4 and 3 in the LR and OSR groups, respectively. Simple suture or clip closure was performed in 27 patients, and laparoscopically pedicled omental patch repair was performed in two patients. There was no significant difference in operative time and length of hospital stay between the LR and OSR groups. Treatment failed in two patients because of severe sepsis and multiple organ dysfunction syndrome, including one with fungal peritonitis. Surgery for pediatric UGI perforations should be selected according to the general status of the patient, age of the patient, duration from symptom onset, inflammation, and perforation site and size. Antibiotic administration and surgical closure remain the main strategies for pediatric UGI perforations.

755 Management of Perforated Peptic Ulcer in Laparoscopic Era

Abstract Aim We want to share our initial experience in treating Perforated Peptic ulcer by mini-invasive techniques. Method Retrospectively, data was collected by looking at surgical files for patients who were admitted with perforated peptic Ulcers under an experienced consultant surgeon between 2016 and 2021 at Benghazi Medical Centre in Libya. Only patients were managed laparoscopically were included and were managed by the same surgeon. Results In the period of 2016 until 2021, 18 patients with perforated peptic ulcers were treated laparoscopically in our hospital.All were men except three women, age ranged from 23 years to 56 years. Laparoscopy was attempted in all patients , none of the cases were converted to open , 14 patients of perforations were located in the first part of duodenum (80%) and 4 were pre-pyloric , simple closure with omental patch were enough to close the perforation, copious peritoneal lavage with normal saline access to all abdominal compartments is very easy and never can be reached in open surgery. Mean operative time was 90min (60-120 min). the hospital stay ranged from 3 to 7 days. with no morbidity, leak , and no mortality within 30 days. Conclusions We shared our experience for management of perforated Peptic ulcer at Benghazi Medical Centre, by managing 18 patients with perforated viscus Laparoscopically. Laparoscopy is safe and permits successful primary suture closure of perforated duodenal and gastric ulcer and provides excellent access to different regions of the abdomen for better lavage. Furthermore, it confers benefits on patients in the form of reduced postoperative pain, and early recovery.

Full-thickness defect closure using the reopenable clip over-the-line method with omental patch.

Full-thickness defect closure using the reopenable clip over-the-line method with omental patch.

Wound healing of gaster perforation with Human Dried Amniotic Membrane (H-DAM) as biomaterial patch viewing from the fibroblasts counts and collagen density

Link of Video Abstract: https://youtu.be/UldBMnzIelE Background: Gastric perforation in neonates is an emergency in neonatology with a mortality rate of up to 75%. Many studies have been carried out to improve tissue healing, including using various surgical techniques and materials, one of which is using H-DAM technology. Therefore, this study aims to evaluate the differences in the number of fibroblasts and collagen density in gastric perforation repair with H-DAM as a biomaterial patch compared to using an omental patch in New Zealand white rabbits. Methods: A true-experimental study was conducted among 30 samples of rabbits and none of them dropped out. The inclusion criteria for this study are New Zealand White Rabbit male sex, age 6-9 months with a weight of 2-3 kg, healthy and active. The Exclusion criteria for this study are rabbits not fasted for 12 hours. During the 12-hour fasting period, it behaved aggressively, attacked other rabbits, and found surgical site infection. Data were analyzed using SPSS version 25.0 for Windows. Results: From the examination results, there was a significant difference in gastric healing in terms of examining the number of fibroblasts with the Kruskal-Wallis test (p=0.000. The One-way ANOVA analysis found that the three data groups had no significant difference (p=0.234). Conclusion: There is an increase in the number of fibroblasts and collagen density in gastric perforation repair with H-DAM as a biological dressing compared to primary repair of gastric perforation using an omental patch in rabbit models so that H-DAM can be the repair technique of choice in gastric perforation in the rabbit.

Comparative study of laparoscopic versus open peptic perforation repair

Background: Peptic perforation is very common emergency in general surgery. Peptic perforation is the terminology used for perforation of duodenal ulcer or perforation of gastric ulcer. Peptic perforations require surgical intervention by Graham’s omental patch repair. This surgical intervention can be done by laparoscopic or open surgery. Methods: The study was carried out in 40 patients between June 2022 to April 2023. In this study, we have included all the patients who present to emergency department with peptic perforation either gastric or duodenal. Patients who present with gastric perforation with/due to carcinoma and peptic perforation with septicemia and ARDS are not included in this study. In this study, patients were randomly allocated in two groups: group A (n=20) includes laparoscopic peptic perforation repair. And group B (n=20) includes open peptic perforation repair. Author have compared two groups in terms of intraoperative time, post-operative hospital stay and post-operative complications like surgical site wound infection, post-operative pain. Results: This study shows that there is no significant difference in intraoperative time between two groups but significant decrease in hospital stay, surgical site wound infection and post-operative pain in group A patient than in group B patients. Conclusions: Laparoscopic peptic perforation repair significantly reduces post-operative pain, surgical site infection and hospital stay.