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Rizwan Ali
Ahmed Hussain Pathan
Imtiaz Ali Langah
Muhammad Ghazi Asad Khan
Imtiaz Ali Soomro
Shah Nawaz Khatti


Graham omentopexy, duodenal rupture, complications, anastomotic leakage


Background: Perforations in the duodenum are a common surgical emergency that carry a high risk of morbidity and death. Helicobacter pylori infection is the main cause of duodenal ulcers, yet long-term use of non-steroidal anti-inflammatory medicines (NSAIDs) can also contribute to the formation of ulcers. The standard treatment for duodenal ulcer perforation is Graham omentopexy. However, 9% of patients experience leakage following this treatment, which has a 44.4% fatality rate.

Objective: To examine the clinical symptoms at presentation, postoperative complications, and risk factors linked with duodenal leakage after Graham omentopexy for perforated duodenal ulcer.

Study design: cross sectional study

Place and Duration: This study was conducted in Liaquat University Hospital Hyderabad/Jamshoro from January 2023 to January 2024

Methodology: Purposive sampling with non-probability technique was used. All patients, regardless of gender, who received emergency surgery for duodenal perforation over the age of twelve years were included in the study. A thorough history and physical examination were performed, and vital signs as well as information regarding duration of symptoms prior to presentation were gathered using a premade form.

Results: There were a total of 80 participants of this study. Majority of them were males. All of the participants were aged between 12 to 65 years. The average age calculated was 28.4 years. PT/INR was deranged in 16 (20%) patients. Majority of the participants presented within 24 hours of onset symptoms. Serum albumin levels were low in six (7.5%) patients. Serum creatinine was elevated in 15 (18.75%) individuals. During the exploration, over 1000 cc of contaminated peritoneal fluid was evacuated from 16 (20%) patients.

Conclusion: In summary, wound infection, paralytic ileus, anastomotic leakage, ruptured abdomen, and respiratory failure are frequent complications that follow Graham omentopexy.

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1. Zahid A. Clinical Presentation, Postoperative Complications and Risk Factors of Duodenal Leakage After Graham Omentopexy for Duodenal Ulcer Perforation. Journal of Surgery Pakistan. 2023 Mar 31;28(01):19-22.
2. Jat MA. Comparative Evaluation of Graham’ s Omentopexy Versus Modified Graham’ s Omentopexy in Perforated Duodenal Ulcers. Annals of King Edward Medical University. 2016 Sep 9;22(3).
3. Abdallah HA, Abd-El-Aal AS. Comparative study between Graham’s omentopexy and modified-Graham’s omentopexy in treatment of perforated duodenal ulcers. The Egyptian Journal of Surgery. 2018 Oct 1;37(4):485-9.
4. Taj MH, Mohammad D, Qureshi SA. Outcome of omentopexy as primary repair in perforated duodenal ulcer. Journal of the College of Physicians and Surgeons--pakistan: JCPSP. 2007 Dec 1;17(12):731-5.
5. Dogra P, Kaushik R, Singh S, Bhardwaj S. Risk factors for leak after omentopexy for duodenal ulcer perforations. European Journal of Trauma and Emergency Surgery. 2023 Apr;49(2):1163-7.
6. Deivassigamany E, Kandhasamy S. Comparison of Graham Omentoplastyand Modified Graham Omentopexyin PerforatedDuodenalUlcer: A Prospective Cohort Study. Pakistan Heart Journal. 2024 Jan 30;57(1):161-7.
7. Gujar N, Awati J, Mudhol S, Contractor S, Choudhari R, Garag S. Immediate results of omentopexy in perforated duodenal ulcer: a study of 186 cases. Al Ameen J Med Sci. 2012;5(1):29-38.
8. Parihar S, Mathur PN, Joshi CP. Evaluation of large duodenal ulcer perforation with special reference to omentopexy and omental plugging. International Surgery Journal. 2016 Dec 9;3(3):1229-33.
9. Read RC, Thompson BW. Gastric outlet obstruction after omentopexy for perforated “acute” and “chronic” duodenal ulceration. The American Journal of Surgery. 1975 Dec 1;130(6):682-7.
10. Yunas M, Jan QA, Nisar W, Imran M. Grahm’s omentopexy in closure of perforated duodenal ulcer. Journal of Medical Sciences. 2010 Apr 5;18(2):87-90.
11. Chan KS, Wang YL, Chan XW, Shelat VG. Outcomes of omental patch repair in large or giant perforated peptic ulcer are comparable to gastrectomy. Eur J Trauma Emerg Surg. 2019; 019-01237-8
12. Yoon, Kim HO, Jung KU, Lee SR. The laparoscopic single figure of eight suturing omentopexy for the treatment of a perforated duodenal ulcer. J Minim Invasive Surg. 2019;22:23-8. 2019.22.1.23
13. Malik M, Parveen S, Iqbal M, Khan M. Frequency of peptic ulcer perforation during fasting and without fasting. J Surg Pakistan. 2015;20:32-5.
14. Aziz F, Geibel J. Surgical treatment of perforated peptic ulcer. Background, indications for surgery vs conservative management, general surgical considerations. Medscape. 2022. [Internet] Available from emedicine.medscape. com/article/1950689- overview?reg=1#a4
15. Sverden,AgreusL,DunnJ M, LagergrenJ. Peptic ulcer disease. BMJ. 2019;367:l549
16. Bejiga G, Negasa T, Abebe A. Treatment outcome of perforated peptic ulcer disease among surgically treated patients: A crosssectional study in Adama Hospital Medical College, Adama. Ethiopia. Int J Surg. 2022;48:100564. j.ijso.2022.100564.
17. Teshome H, Birega M, Taddese M. Perforated peptic ulcer disease in a tertiary hospital, Addis Ababa, Ethiopia: Five Year retrospective study. Ethiopian J of Health Sci. 2020;30(3)
18. Bupicha JA, Gebresellassie HW, Alemayehu A. Pattern and outcome of perforated peptic ulcer disease patient in four teaching hospitals in Addis Ababa Ethiopia: A prospective cohort multicenter study. BMC Surg. 2020; 20(1)
19. Magsi A, Iqbal M, Malik M, Parveen S. Silent peptic ulcer disease perforation. J Surg Pakistan. 2017; 10.21699/jsp.22.2.7.
20. Dogra P, Kaushik R, Singh S, Bhardwaj S. Risk factors for leak after omentopexy for duodenal ulcer perforations. Eur J Trauma Emerg Surg. EPUB 2022; 10.1007/s00068-022-02058-y

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