Outcome of omentopexy as primary repair in perforated duodenal ulcer

Objective: This study was conducted to determine the short-term complications and duration of hospital stay in patients treated with omentopexy as primary repair in perforated duodenal ulcer that were more than 12 hours old and more than 0.5 cm in size. Study Design: Case-series study. Place and Duration of Study: Department of General Surgery, Bolan Medical College, Quetta from January 2006 to January 2007. Patients and Methods: Thirty consecutive patients of perforated duodenal ulcer in whom the duration of perforation was greater than 12 hours and size of perforation was greater than 0.5 cm were included in this study. After adequate resuscitation, emergency laparotomy was performed and primary repair with pedicled omental patch performed without primary suturing of the perforation. A thorough peritoneal lavage was done with normal saline. Postoperatively, all the patients were given intravenous fluids, antibiotics and H2-receptor blockers. All the patients were closely monitored for the development of any postoperative complication. All the findings were recorded on a pre-designed proforma. Duration of hospital stay was noted at the time of discharge. All the patients were discharged on proton pump inhibitors, prescribed for 6 weeks. Results: Perforation was present on the anterior surface of the first part of duodenum in all cases. Size of perforation varied from 0.6 cm to 1.5 cm. Median size was 0.8 cm. Wound infection was seen in 10 (33.3%) patients and pneumonia in 7 (23.3%) patients. Two (6.7%) patients developed burst abdomen and residual pelvic collection that required re-operation. Overall, 15 (50%) patients did not develop any complication. Mortality was 1 (3.3%). Median hospital stay was 9 days. Conclusion: Omentopexy with thorough peritoneal lavage is simple and safe procedure with low mortality and fewer post-operative complications. It does not require great expertise and can be performed in a very short time in seriously ill patient. It should be chosen instead of an acid reducing operation in an emergency setting.