Management of perforated large/giant peptic ulcers: a comparative prospective study between omental plug, duodenal exclusion, and jejunal serosal patch

Khalifa, Mohamed S.; Hamed, Mohammed A.; Elhefny, Amr M.M.

doi:10.4103/ejs.ejs_60_21

Management of perforated large/giant peptic ulcers: a comparative prospective study between omental plug, duodenal exclusion, and jejunal serosal patch

Authors

Abstract

Background
Large/giant peptic ulcer (duodenal ulcer and benign gastric ulcer) perforation is a serious life-threatening surgical emergency, with high morbidity and mortality rates. Despite that, no single surgical approach has yet been shown to be superior to others.
Patients and methods
This is a prospective randomized study comparing the efficacy of omental plugging, duodenal exclusion, and jejunal serosal patch as different alternating operative techniques in managing such a problem.
Results
Thirty patients with large/giant peptic perforation more than 2 cm in diameter were included over a period of 24 months. Patients were divided into three groups (A, B, and C) according to surgical approach applied. Males/females were 27/3, average age was 45–73 years old, and mean operative time was 75±28.4 min. Biliary leak rates were 3.3, 10, and 6.6% in group A (omental plug), group B (jejunal serosal patch), and group C (duodenal exclusion and gastrojejunostomy), respectively, with value of 0.199.
Conclusion
The management of large/giant peptic (duodenal ulcer and gastric ulcer) perforations is difficult and presents a great challenge to surgeons. Duodenal stump leaks can carry high incidence of morbidity and mortality. Multiple surgical modalities are available to deal with such surgical problems.

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