Purpose: The purpose of the present study is to examine the Grahms Omentopexy, Figure of 8 and Laparoscopic peptic ulcer perforation closure procedure and the associated operative risks among the patients.

Method: The study was conducted among 180 patients who were admitted at the Tertiary care centre with gastric perforations. The perforation present in all the study subjects was closed using either Grahms patch (omentopexy), Figure of 8 or Laparoscopy under general anaesthesia. Any complications such as wound complication, pleural effusion, lung consolidation or biliary leak, death were recorded. The data obtained were recorded and suitable statistical analyses were performed.

Results: The mean time taken for starting oral feeding, the time for removal of Ryle’s tube as well as the length of hospital stay was found to be the highest among the patients operated using Grahms patch while the least was observed for patients performed using laparoscopy. The percentage of patients with wound complications, lung complications, biliary fistula and death post surgery was found to be the highest in the Grahms patch group and lowest for the laparoscopic group. It was also observed that patients with smoking, alcohol consumption habit and history of APD had a higher risk for increased perforation size.

Conclusion: The study concluded that Figure of 8 being a new technique can be used in small, friable edges of perforation, and having less post operative complications than Grahms patch and also decreases length of hospital stay, oral feeding start as well as Ryle’s tube removal day.

Keywords: Biliary fistula, Figure of 8, Grahm’s Omentopexy, Laparoscopic, Peptic ulcer perforation.

1. Soreide K, et al., Perforated peptic ulcer. Lancet, 386(10000): p. 1288-98,2015
2. Sarda, D.K. and P.K. Garg, Study of Incidence of Peptic Ulcer Perforation in Young Adults: A Hospital Based Study. International Archives of BioMedical and Clinical Research, 4(1): p. 120-123,2018
3. Arora, B.K., R. Arora, and A. Arora, Modified Graham’s repair for peptic ulcer perforation: reassessment study. International Surgery Journal, 4(5): p. 1667-1671,2017
4. Bhandari, V., et al., A comparative study between figure of eight suturing technique and omentopexy in closure of peptic ulcer perforation: a prospective study on 60 patients with APACHE II score≤ 10. International Surgery Journal, 2(1): p. 31-37,2016
5. Chung, K.T. and V.G. Shelat, Perforated peptic ulcer - an update. World J Gastrointest Surg, 9(1): p. 1-12,2017
6. Koliwad V., Naveen N., and M. V., A clinicopathological study of duodenal ulcer perforation and its management in a rural area, Karnataka. International Journal of medical and applied sciences, 2(4): p. 47-57,2013
7. Istl, A.C. and D.K. Gray, Roscoe R. Graham: An enduring legacy in the 21st century. J Trauma Acute Care Surg, 82(1): p. 216-220,2017
8. Bertleff, M.J. and J.F. Lange, Perforated peptic ulcer disease: a review of history and treatment. Digestive surgery, 27(3): p. 161-169,2010
9. Asali, A.M., et al., Risk factors leading to peptic ulcer disease: systematic review in literature. International Journal Of Community Medicine And Public Health, 5(10): p. 4617-4624,2018
10. Ramakrishnan, K. and R.C. Salinas, Peptic ulcer disease. American family physician, 76(7),2007
11. Gupta S.P., A safer technique of closure of peptic ulcer perforation. Indian Journal of Surgery, 73(5): p. 361-362,2011
12. Choudhary, L., et al., A new and safer surgical technique figure of eight stitch for management of perforated peptic ulcer. Journal of Evolution of Medical and Dental Sciences, 3(19): p. 5299-5307,2014
13. Luncă, S., Romedea N. S., and M. C., Laparoscopic repair of perforated peptic ulcer. Jurnalul de chirurgie, 3(2): p. 171-176,2007
14. Palanivelu, C., K. Jani, and P. Senthilnathan, Laparoscopic management of duodenal ulcer perforation: is it advantageous? Indian Journal of Gastroenterology, 26(2): p. 64,2007
15. Motewar, A., et al., Laparoscopic versus open management of duodenal perforation: a comparative study at a District General Hospital. Przeglad gastroenterologiczny, 8(5): p. 315,2013

Dr Pravin K. Ladda

Department of Surgery, Govt. Medical College, Aurangabad (M.S.), India