Laparoscopic repair of perforated duodenal ulcers: the“three-stitch” Graham patch technique

Introduction: For many surgeries for duodenal ulcer Laparoscopic repair has become gold standard for many elective procedures such as ant reflux procedures, laparoscopic cholecystectomy and in colorectal surgery. Although in the emergency setting such as in the management of perforated duodenal ulcer Laparoscopic repair has been slow and limited. Since 1990, for the treatment of perforated peptic ulcer Laparoscopic repair has been used which has been widely accepted as an effective method. Duodenal ulcer is defined as a peptic ulcer which develops in the first part of the small intestine called duodenum and usually present as a perforation of acute abdomen. In perforated duodenal symptoms as severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually followed by nausea and vomiting. In this situation there is rapid generalization of pain and in examination shows peritonitis with lack of bowel sounds. Aim: The main objective of this study is to evaluate outcome of laparoscopic surgery in comparison with conventional surgery. Material and methods: All the patients with clinically diagnosed with perforated duodenal ulcers presenting within 24 hours of symptoms and undergoing surgery were included during the study period. Total 50 patients were included with age group 15-65 years. All the patients with perforated duodenal ulcers were included which go through either conventional open or laparoscopic without omental patch repair. Result: Total 50 patients were included in these studies which were divided into two group with 25 patients in each group as laparoscopic duodenal perforation repair group and conventional open repair group. Mean duration of operation (in minutes) was 105.4±10.4 in laparoscopic duodenal perforation repair group whereas mean duration of operation (in minutes) was 67.3±8.6 in conventional open repair group. Mean duration of number of doses of analgesics required in laparoscopic group and conventional open group as 9.5±1.7 and 17.2± 3.1 respectively. Out of 25 patients in each group of laparoscopic duodenal perforation repair group and the conventional open repair group the outcome were noted with their post operative complication as shown in table no 5 below. In Post-operative complications 21(84%) patients in laparoscopic duodenal perforation repair group and 14(56%) patients in conventional open repair group had no complications. 4 (16%) patients in the laparoscopic duodenal perforation repair group and 2(8%) patients in conventional open repair group showed Post-operative complications as chest infection. In the conventional open repair group patients present with wound dehiscence and wound infection and Wound dehiscence and chest infection were 4(16%) and 5(20%) respectively whereas nil in Laparoscopic duodenal perforation repair group. Conclusion: Duodenal ulcer perforation is a life-threatening emergency which required urgent management for the patients. Due to the advance in duodenal ulcer perforation closure by laparoscopy it becomes popular and favorite choice. With certain criteria, laparoscopic closure of perforated duodenal ulcer is safe and effective though it was associated with longer operating time and had no impact on the outcome. Hence laparoscopic closure was better in comparison to open repair for the earlier returns to normal daily activities. Keywords: Duodenal ulcer, Laparoscopic repair, Post-operative analgesia, conventional surgery

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Evaluating the Evolving Morbidity of Omentoplasty for Perforated Peptic Ulcer Disease

The American Surgeon ◽

10.1177/0003134820964226 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1289-1295

Author(s):

Noah Swann ◽

Nobel LeTendre ◽

Brian Cox ◽

James Recabaren

Keyword(s):

Laparoscopic Surgery ◽

Laparoscopic Repair ◽

Open Surgery ◽

Surgical Repair ◽

Open Repair ◽

Perforated Peptic Ulcer ◽

Morbidity And Mortality ◽

Patch Repair ◽

Perioperative Morbidity ◽

Graham Patch

Mortality for perforated peptic ulcer (PPU) surgery ranges from 2-22% with morbidity ranging from 15-45%. Traditionally, these had been repaired with vagotomy and antrectomy or pyloroplasty with smaller perforations repaired with an omentoplasty. Laparoscopic repair has become increasingly prevalent and demonstrated to have shorter length of stay (LOS) and fewer complications. We are evaluating the surgical repair of PPU with omentoplasty to determine trends of utilization and surgical outcomes. We conducted a 13-year (2005-2017) retrospective review, utilizing the National Surgical Quality Improvement Program database. A total of 6873 patients had open or laparoscopic repair of a PPU, with 2285 patients identified as utilizing omentoplasty. Five hundred eighty-eight omentoplasty patients were further identified as having a laparoscopic technique. We compared patient demographics, comorbidities, and perioperative morbidity and mortality for surgical patients between 2005-2011 and 2012-2017. We trended the perioperative outcomes across the study intervals. Parametric and nonparametric tests were used to evaluate outcomes. Between 2005 and between 2017, laparoscopic surgical repair with omentoplasty has increased from 3.8% to 34.6%. Overall mortality for open operations declined during this interval (12.7%-9.3%) while it remained unchanged for laparoscopic operations (4.6%-4.2%), there was not a significant difference between the laparoscopic and open 30-day mortality. Both open surgery and laparoscopic surgery are being used on an increasingly healthy cohort (increased functional status decreased predicted perioperative morbidity). Relative to the 2005-2011, the laparoscopic surgery 2012-2017 cohort had increases in both serious and overall morbidity, although this was not statistically significant. Compared to the 2005-2011, the 2012-2017 open surgery cohort had increasing serious morbidity (OR 2.03) and overall morbidity (OR 1.91). There was a trend of decreasing LOS and increased return to the operating room for patients with laparoscopic surgery. Laparoscopic Graham patch repair of peptic ulcers significantly increased, although open repair still constitutes the majority of the cases. Despite Graham patch repair being utilized on a healthier patient population, morbidity and mortality for laparoscopic repair have remained unchanged. Postoperative morbidity and mortality for open surgery have increased. This indicates that laparoscopic repair is more commonly utilized for low- or medium risk patients, leaving an increasingly sick patient population selected to open repair.

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THE ROLE OF NASOGASTRIC TUBE AFTER LAPAROSCOPIC REPAIR OF SMALL PERFORATION OF DUODENAL ULCERS IN LOW RISK PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.4.9 ◽

2019 ◽

pp. 66-70

Author(s):

Huu Tri Nguyen

Keyword(s):

Nasogastric Tube ◽

Laparoscopic Repair ◽

Postoperative Hospital Stay ◽

Low Risk ◽

Duodenal Ulcers ◽

Risk Patients ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The aim of this study was to evaluate the role of nasogastric tube after laparoscopic repair of small peforation of duodenal ulcers in low risk patients. Methods: A retrospective study on 69 consecutive perforated duodenal ulcer patients with size of perforation of less than 5 mm, ASA score of less than 4, Boey score of less than 2, treated with laparoscopic repair at Hue University of Medicine and Pharmacy Hospital from January 2012 to June 2018. Patients were divided into two groups: group 1 with postoperative nasogastric tube and group 2 without postoperative nasogastric tube because patients were uncooperative and removed the nasogastric tube themselves. Results: The mean age was 47.8 ± 14.7 years. Male/female ratio was 22. The mean of duration from symptom onset until surgery was 7.5 ± 5.5 hours. 60 patients (87.0%) had a Boey score of 0 and nine patients (13.0%) had a Boey score of 1. The mean of size of perforation was 3.5 ± 1.0 mm. All of perforations were on the anterior duodenal wall. The patients in the group 2 had a significantly shorter interval between surgery and passage of first flatus than in group 1 (1.8 ± 0.5 days vs 2.6 ± 0.7 days (p = 0.042)), had a significantly shorter postoperative hospital stay than in group 1 (4.5 ± 0.6 days vs 5.8 ± 0.8 days (p = 0.026)). There was no significant difference between group 1 and group 2 in the duration of analgesic use (2.3 ± 0.5 days vs 2.8 ± 0.8 days, p = 0.097). There was no morbidity or mortality in two groups. Conclusions: The patients without postoperative nasogastric tube had a significantly shorter interval between surgery and passage of first flatus and postoperative hospital stay. The use of postoperative nasogastric tube in small perforations of duodenal ulcers in low risk patients seems to be unnecessary. Key words: Perforated duodenal ulcer, laparoscopic repair, laparoscopic surgery, nasogastric tube

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Laparoscopic Repair of a Large Duodenal Perforation Secondary to an Indwelling Nasogastric Tube in a Tracheotomized Adult

Case Reports in Surgery ◽

10.1155/2013/503151 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sanoop Koshy Zachariah

Keyword(s):

Nasogastric Tube ◽

Laparoscopic Repair ◽

Open Surgery ◽

English Literature ◽

Duodenal Perforation ◽

Duodenal Ulcers ◽

Conversion To Open Surgery ◽

Large Perforation ◽

Duodenal Perforations

Laparoscopic repair of perforated duodenal ulcers is safe and effective in centers with experience and increasingly performed by laparoscopic surgeons. However, the role of laparoscopy for the management of large duodenal perforations (>1 cm) is unclear. To date, no experience has been reported with emergency laparoscopic repair of large perforations for gastroduodenal ulcers. The commonest reason for conversion to open surgery is a perforation size of more than 1 cm. This paper reports a case of a large duodenal perforation due to a nasogastric tube in a 26-year-old male who had undergone a tracheostomy, following a cut-throat injury. This large perforation was successfully diagnosed and repaired laparoscopically. This is probably the first paper in the English literature to report duodenal perforation due to a nasogastric tube in an adult and also the first report of a successful laparoscopic repair of a large duodenal perforation.

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Laparoscopic repair of perforated duodenal ulcers using collagen fleece coated with fibrin glue

Minimally Invasive Therapy ◽

10.3109/13645709509152780 ◽

1995 ◽

Vol 4 (4) ◽

pp. 215-217 ◽

Cited By ~ 3

Author(s):

A. J. W. Sim ◽

Y. El Ashaal ◽

K. Ramadan ◽

V. P. Prem Chandran ◽

M. Sebastian ◽

...

Keyword(s):

Fibrin Glue ◽

Laparoscopic Repair ◽

Duodenal Ulcers

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Single-Port Laparoscopic Repair of Perforated Duodenal Ulcers

World Journal of Surgery ◽

10.1007/s00268-019-05352-w ◽

2020 ◽

Vol 44 (5) ◽

pp. 1425-1430

Author(s):

Tri Huu Nguyen ◽

Thanh Nhu Dang ◽

Thomas Schnelldorfer

Keyword(s):

Laparoscopic Repair ◽

Single Port ◽

Duodenal Ulcers

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Laparoscopic Repair of Perforated Duodenal Ulcers

Archives of Surgery ◽

10.1001/archsurg.134.8.845 ◽

1999 ◽

Vol 134 (8) ◽

pp. 845 ◽

Cited By ~ 58

Author(s):

Namir Katkhouda

Keyword(s):

Laparoscopic Repair ◽

Duodenal Ulcers

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Roscoe Reid Graham (1890 to 1948): A Canadian Pioneer in General Surgery

The American Surgeon ◽

10.1177/000313481408000512 ◽

2014 ◽

Vol 80 (5) ◽

pp. 431-433 ◽

Cited By ~ 2

Author(s):

Christine C. Piper ◽

Charles J. Yeo ◽

Scott W. Cowan

Keyword(s):

General Surgery ◽

The United States ◽

Patch Repair ◽

Duodenal Ulcers ◽

Omental Patch ◽

University Of Toronto ◽

Surgical Career ◽

Graham Patch ◽

The University ◽

Physical Findings

Roscoe Reid Graham, a Canadian surgeon trained at the University of Toronto, was a true pioneer in the field of general surgery. Although he may be best known for his omental patch repair of perforated duodenal ulcers—often referred to as the “Graham patch”—he had a number of other significant accomplishments that decorated his surgical career. Dr. Graham is credited with being the first surgeon to successfully enucleate an insulinoma. He ventured to do an essentially brand new operation based solely on his patient's symptoms and physical findings, a courageous move that even some of the most talented surgeons would shy away from. He also spent a large portion of his career dedicated to the study of rectal prolapse, working tirelessly to rid his patients of this awful affliction. He was recognized by a number of different surgical associations for his operative successes and was awarded membership to those both in Canada and the United States. Despite all of these accolades, Dr. Graham remained grounded and always fervent in his dedication to the patient and their presenting symptom(s), reminding us that to do anything more would be “meddlesome.” In an age when medical professionals are often all too eager to make unnecessary interventions, it is imperative that we look back at our predecessors such as Roscoe Reid Graham, for they will continually redirect us toward our one and only obligation: the patient.

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