Abstract

In this issue of the Southern Medical Journal, Jani et al¹ present a prospective randomized study of 100 patients with acute duodenal perforations. The patients were randomized to either Graham omentopexy or omental plugging technique. The primary endpoint of the study was postoperative mortality. The secondary endpoints were postoperative suture line leak, postoperative hemorrhage, and evidence of gastric outlet obstruction by endoscopy and upper GI barium study. All duodenal perforations were at least 2 cm in size. Nearly half the patients had a history suggestive of chronic ulcer symptoms for more than 3 months' duration. The authors did not indicate the number of patients who presented in shock. The mean age in both groups was less than 40 years old with a male predominance. Gastrograffin upper GI study detected a suture line leak in six patients treated with a Graham patch (12%), but none in the omental plug group. This difference was found to be statistically significant. The postoperative mortality rate was 16% (8 patients) in the omentopexy group and 8% (4 patients) in the omental plug treatment arm. All deaths in the study were attributed to sepsis. Early gastric outlet obstruction was significantly greater in the omentopexy group, but at five years, this difference was insignificant. The authors concluded that the technique of omental plugging had a significantly lower leak rate and was less likely to obstruct the pylorus compared with the Graham technique.