A randomized study to compare the clinical outcomes of modified graham’s omentopexy vs graham’s omentopexy in perforated duodenal ulcers

Introduction: The most accepted method of surgical closure of the peptic ulcer perforation till now has been the Graham’s patch repair. Described by Roscoe Graham of Toronto in 1937, where a patch of omentum was used to seal the perforation with no attempt at closing the perforation primarily. Modification of the same is the Modified Graham’s Omentopexy wherein the perforation is primarily closed with sutures followed by placement of omental patch and re-knotting of sutures. Recent data suggests that both the procedures have comparable outcomes, however the modified technique could have a significant advantage over the conventional technique in terms of postoperative outcomes like re-leaks, surgical site infection and length of hospital stay.
Material & Methods: Our study was aimed to study the clinical outcomes of Modified Graham’s Omentopexy versus Graham’s Omentopexy in patients of duodenal ulcer perforation. A total of sixty patients were included in our study, 30 patients each in case group A Modified Graham’s Omentopexy (MGO) and control group B Graham’s Omentopexy (GO). The cases for the study were randomized using sealed envelope technique. In the case group (group A), all the patients underwent Modified Graham’s Omentopexy and in the control group (group B), all the patients underwent Graham’s Omentopexy. The patients were followed up for a period of 30 days to see the clinical outcomes.
Results: The day of Ryle’s tube, abdominal drain output, day of abdominal drain removal, incidence of surgical site infection, biliary leak, mortality and length of hospital stay were assessed and were found to be similar in both the groups (A & B). Only the difference in Length of hospital stay between the two groups was found to be statistically significant with shorter duration of hospital stay in patients who underwent Modified Graham’s Omentopexy (Group A) as compared to those who underwent Graham’s Omentopexy (Group B). Though the incidence of surgical site infection and post-operative biliary leak were found to be higher in Graham’s Omentopexy group (Group B) it was not statistically significant enough to state that Modified Graham’s Omentopexy is better than Graham’s Omentopexy.
Conclusion: As both the procedures of duodenal perforation repair were almost comparable in terms of day of Ryle’s tube removal, abdominal drain output, day of abdominal drain removal, incidence of surgical site infection, biliary leak and mortality, except with the advantage of shorter hospital stay in patients undergoing Modified Graham’s Omentopexy. Hence it is concluded from our study that Modified Graham’s Omentopexy can be considered as a safe and effective alternative to the standard Graham’s Omentopexy in patients with perforated duodenal ulcers.