Surgical Techniques of Closure of Peptic Perforation and their Outcomes
Journal Title: New Indian Journal of Surgery - Year 2017, Vol 8, Issue 4
Abstract
Introduction: Peptic ulcer is one of the most common disease leading to perforations. Only by early diagnosis and treatment, it is possible to reduce the still relatively high mortality. The perforation and resultant peritonitis are immediate threats to the life. The therapeutic priorities are the treatment of peritonitis and securing the closure of perforation with a surgical procedure. Even with the better understanding of the disease, effective resuscitation and prompt surgery under modern anesthesia techniques, there is high morbidity and mortality. Aim and Objectives: The main aim of my study is to study multiple factors causing a peptic ulcer and its perforation and outcome of various surgical techniques of the closure of peptic perforation. Material and Methods: In the present study, a total of 180 patients admitted with peptic perforations at tertiary care center were included during December 2012 to August 2014. A detailed history was recorded. Other data like the condition of the patient at the time of admission, the duration of symptoms and surgery and mode of treatment were recorded. Those patient managed conservatively i.e placement of drains, were not included in this study. After confirmed diagnosis, resuscitation, the patients underwent simple closure without any definitive surgery by various techniques like Grahm’s patch (omentopexy), Figure of eight, Laparoscopic closure of perforation and Omental plugging. Results: The peak age incidence 51.11% was seen in the age group of 41 to 60 years. All the 180 patients of peptic perforation presented with pain in the abdomen and vomiting was present in 120 cases. Distension was present in about 135 patients, mostly in those presented after 24 hrs and 48 hrs of symptoms. Mortality was higher in patients coming late. i.e. after 48 hrs. The incidence of peptic perforation was more in smokers, alcoholics and NSAIDS users. Majority of the patients 140 (77.77%) were operated through Grahm’s patch technique for all sizes of perforation, 33 (18.33%) patients were operated through the figure of eight suture and 7 patients were operated laparoscopically. In majority 60 (33.33%) of cases wound complications was a major complication. The oral feeding starting day in Grahm’s patch was 5.2 days, for the figure of 8 stitch was about 4.3 days and for laparoscopy 4 days. The hospital stay for Grahm’s patch technique was for about 11 days while for laparoscopy was about 8.3 days. Conclusion: In the present study, it could be concluded that peptic ulcer perforation still remains one of the most common causes of abdominal catastrophe. After careful review of published data and numerous discussions, we hope that figure of 8 stitch can be a better alternative to Grahm’s surgery, as it is associated with fewer complications and mortality rate with less operative time. While though laparoscopy technique shows promising results, it requires expensive set up with surgical expertise with more operative time.
Authors and Affiliations
Anita Kandi
Keywords
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- EP ID EP473482
- DOI 10.21088/nijs.0976.4747.8417.17
- Views 78
- Downloads 0
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