Comparative Evaluation of Graham’s Omentopexy Versus Modified Graham’s Omentopexy in Perforated Duodenal Ulcers

Abstract

Perforated peptic ulcer is a serious and the most frequent complication of peptic ulcer disease which demands urgent diagnostic procedure, reanimation and surgical intervention.

Objective:  To compare Graham's omentopexy versus modified Graham’s omentopexy in perforation of duodenum due to peptic ulcer disease in terms of post- operative complications and better outcome.

Patients and Methods:  This randomized control trial study had included 84 cases of perforation of duodenum due to peptic ulcer disease which were randomized by using random number table into two groups Graham’s Omentopexy 42 cases  group A and modified Graham’s Omentopexy 42 cases group B. The Patients with gastric perforation or other parts of the bowel were excluded. The present study was conducted in the Department of Surgery, at Ghulam Muham-mad Mahar Medical College Sukkur from May 2009 to April 2012. All patients were post operatively followed-up for the period of 12 months at outpatients department.

Results:  Out of 84 patients, 76 {90.5%} were males and 8 {9.5%} were females with M: F ratio 9.5:1. The peak age of patients at presentation was between 30 – 49 years (61.8%). In group A Graham's omentopexy  there was  wound infection in 13 cases {30%} biliary leakage in 2 cases (4.6%} ,intra-abdominal abscess in 2 cases (4.6%} and 4 patients died (9.5%} but in group B  modified Graham'’ omentopexy, wound infection was noted in 9 cases (21.3 %) but there was no biliary leakage and intra-abdominal abscess .There was three mortalities (7.1%} in group B. The average in- patients hospital stay in group A Graham’s omentopexy  was 11.5 days and in group B modified Graham’s omentopexy 10.0 days.

Conclusion:  Patients undergoing modified Graham's omentopexy in perforated duodenal ulcer had lesser post-operative complications and a shorter hospital stay with better outcome than Graham's omentopexy.