Original Article

Omental Plugging for Large-sized Duodenal Peptic Perforations: A Prospective Randomized Study of 100 Patients

Authors: Kalpesh Jani, MD, A K. Saxena, MD, Rasik Vaghasia, MD

Abstract

Background: Due to friable margins and the moribund state of the patient, managing giant duodenal perforations (>20 mm in diameter) is a challenging task.


Methods: A prospective randomized study of 100 patients with large-sized (> 20 mm) duodenal peptic perforation comparing omental plugging (study group) with omentopexy (control group) was carried out.


Results: Size of the perforation varied between 20 to 30 mm. No study group patients developed a postoperative perforation site leak, as compared with 6 patients in the control group. Gastric outlet obstruction was significantly less at 6 weeks and 5 years in the study group as compared with the control group, and mortality was significantly less in the study group.


Conclusion: It was concluded that omental plugging was a safe and reliable method of treatment for large-sized duodenal peptic perforations.


Key Points


* Giant duodenal ulcers (>20 mm in diameter) are potentially life threatening, with medical therapy alone associated with a morbidity of around 92%.


* Perforation of these ulcers is a surgical catastrophe. Standard technique of omentopexy is associated with high morbidity and mortality.


* Omental plugging is a simple procedure which does not require significant expertise and can be performed emergently in seriously ill patients by a trainee general surgeon.


* It has lower short-term and long-term morbidity as compared with the standard technique of omentopexy for perforation closure.

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