A Study to Compare the Efficacy of Free Omental Graft Against Pedicled Omental Graft in Prevention of Post Operative Leak In Patients With Duodenal Perforations

Abstract

Background: ABSTRACT Duodenal ulcer perforations are a common cause of peritonitis. For almost a century, duodenal perforations have been closed by Omentopexy. In this, a strand of omentum is drawn over the perforation and held in place by full thickness sutures placed on either side of the perforation, and this procedure has become the "gold standard" for the treatment of such perforations. However, occasionally large perforations of the duodenum may be encountered in which there exists the threat of post-operative leakage following closure by this simple method. Commonly, duodenal ulcer perforations are less than 1 cm in greatest diameter, and as such, are amenable to closure by omentopexy. It is generally felt by many surgeons that mobilization of the omentum on its pedicle from the colon, and placement of sutures into the normal duodenum away from the perforation makes the performance of omental patch safe even in the presence of large sized perforations. However there is controversial evidence from some of the studies conducted which proved free omental graft superior to pedicled omental graft. Moreover there is evidence from studies which concluded that a Free Omental Plug can be used safely and reliably to treat large duodenal perforations that are more than 25 mm in size. Objective: To compare the efficacy of Free Omental Graft with Pedicled Omental Graft in preventing post-operative leak in patients with duodenal ulcer perforations of size up to 20 mm. Methodology: A series of 60 cases of duodenal perforations were studied and analyzed. Among them 30 patients underwent closure of duodenal perforation by Pedicled Omental Patching and 30 patients underwent Free Omental Patching. The cases were III followed up for 1 month. The results were analysed and the two groups were compared in terms of post-operative leak rates, post-operative hospital stay, complications & mortality. Results: In the present series we found 33.33% of post-operative leak ( 10 patients) , 30% of duodenal fistula ( 9 patients) , 60% of wound infection ( 18 patients) in patients treated with Free Omental Patch and 6.66% of post-operative leak ( 2 patients) , 3.33% of duodenal fistula ( 1 patient ) , 9.68% wound infection ( 3 patients) in patients treated with Pedicled Omental Patch. we found 13.33% mortality in patients treated with Free Omental Patch and no mortality in patients treated with Pedicled Omental Patch. However the mortality rate was statistically insignificant. The average hospital stay in our series was 11.93 days for Pedicled Omental Patch and 17.03 days for Free Omental patch. Conclusion: Pedicled Omental Patching was found to be a superior surgical technique over Free Omental Patching for the closure of duodenal perforations measuring upto 20 mm.