A randomized comparative study between omentopexy and omental plugging in treatment of duodenal perforation

Abstract

Background: Perforation due to duodenal ulcer is a common cause of peritonitis and is considered as one of the most catastrophic complication of duodenal ulcer perforation. Repair of perforation are considered particularly hazardous because of the extensive duodenal tissue loss, friability of the ulcer margins, surrounding tissue inflammation, poor general condition of the patient and overwhelming sepsis due to bacterial peritonitis. Thus, there is a need to compare closure of duodenal perforations by either Graham’s patch (OX) or omental plugging (OP) which are the simpler and more common methods followed these days in duodenal perforation management.

Methods: The clinical material consists of all inpatients admitted under General Surgery for management of duodenal ulcer perforation at College of Medicine and JNM Hospital, Nadia. The study was conducted during the period from July 2018 to June 2019. This study consisted of 50 consecutive cases and diagnosis was made on the basis of clinical and histopathological findings.

Results: A total of 73 patients were enrolled for the study. All our patients were males. Wound infection (OX -21.1%, OP -14.3%), septicaemia (OX-15.8%, OP-11.4%), and lung complication (OX-13.2%, OP-11.4%) were the commonest complications. Mean postoperative stay for OX was 12.92 with standard deviation 3.00 while in OP was 11.54 with standard deviation 1.54 (statistically significant).

Conclusions:OP is associated with less incidence of postoperative complication in compared to omentopexy procedure for example wound infection, reperforation, lung complication, septicemia and intra-abdominal abscess. OP is associated with less number of mortality. OP is associated with higher mean operative time as it is a relatively newer and less utilized technique.