LAPAROSCOPIC OMENTAL PATCH CLOSURE FOR PERFORATED DUODENAL ULCERS

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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858 Omental Patch Closure With Through the Scope Endoscopic Clips in the Treatment of a Large Iatrogenic Gastric Perforation at Esd

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.172 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB111

Author(s):

David J. Tate ◽

Lobke Desomer ◽

Mayenaaz Sidhu ◽

Michael X. Ma ◽

Michael J. Bourke

Keyword(s):

Gastric Perforation ◽

Omental Patch ◽

Endoscopic Clips ◽

Patch Closure

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Falciform ligament use in perforated duodenal ulcer repair: a case report and literature review

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa243 ◽

2020 ◽

Vol 2020 (11) ◽

Author(s):

Amr Elgazar ◽

Ahmed K Awad ◽

Sheref A Elseidy

Keyword(s):

Duodenal Ulcer ◽

Abdominal Cavity ◽

Clinical Status ◽

Laparoscopic Approach ◽

Greater Omentum ◽

Falciform Ligament ◽

Perforated Duodenal Ulcer ◽

Duodenal Ulcers ◽

Omental Patch ◽

Surgical Conditions

Abstract Acute perforated duodenal ulcers are considered one of the most encountered emergency surgical conditions leading to mortality. Different approaches have been proposed for management based on the clinical status of the patient. The use of omental patch closure is widely accepted either via an open or laparoscopic approach. However, not all patients are candidates owing to the availability and viability of the greater omentum. In these patients, the falciform ligament can be used as an alternative and efficient method for repair. In this case, we present a male patient with a perforated ulcer in the first part of the duodenum which was managed by falciform ligament patch instead of the usual omental patch. In cases of a deficient or unhealthy greater omentum, or if it cannot be brought in the upper part of the abdominal cavity due to severe adhesions, the falciform ligament can be used efficiently in the closure of perforated duodenal ulcer.

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Endoscopic assessment and Helicobacter pylori status evaluation in operated cases of peptic ulcer perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20200310 ◽

2020 ◽

Vol 7 (2) ◽

pp. 535

Author(s):

Prashant Rao ◽

Sarika Mayekar ◽

Vishwajit Pawar ◽

Mohan Achyut Joshi

Keyword(s):

Peptic Ulcer ◽

Ulcer Healing ◽

Eradication Therapy ◽

Peptic Ulcer Perforation ◽

Omental Patch ◽

Ulcer Perforation ◽

Reasonable Approach ◽

Patch Closure ◽

H Pylori ◽

Endoscopic Assessment

Background: Helicobacter pylori’s role in delaying ulcer healing after surgical repair for peptic ulcer perforation causing ulcer persistence hasn’t been definitively established as it has been for uncomplicated ulcers.Methods: Authors performed an endoscopy and H. pylori status evaluation in 30 patients at an average of 6.2 weeks after simple omental patch closure for perforated peptic ulcer.Results: A positive H. pylori status was found in 12 patients (40%) of which 9 had active ulcers. None in the negative group had an active ulcer. H. pylori infection was the only factor found to be responsible for ulcer persistence after surgery.Conclusions: A reasonable approach would thus be to perform an endoscopy 6 weeks after surgery to assess ulcer healing and H. pylori status. H. pylori eradication therapy should then be selectively initialled for patients with an active ulcer or positive H. pylori status.

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Pedicled Tubular Omental Patch for Tamponade of Transfixing Gunshot Bilobar Liver Injury: A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2021.01.13 ◽

2021 ◽

pp. 1-4

Author(s):

Artur Zanellato ◽

Rory Thompson ◽

Gabriella Zanellato ◽

Iwan Collaco ◽

...

Keyword(s):

Balloon Catheter ◽

Gunshot Wounds ◽

Operative Management ◽

Hepatic Cyst ◽

Duodenal Ulcers ◽

Omental Patch ◽

Balloon Catheters ◽

Active Hemorrhage ◽

Liver Injuries ◽

Grade 3

Introduction: Liver injuries are frequent in abdominal trauma and may be managed using a variety of methods. The operative management of deep, penetrating wounds generally involves balloon tamponade of the wound tract using a Sengstaken-Blakemore catheter. Case Presentation: A haemodynamically unstable 34-year-old male with multiple thoracoabdominal gunshot wounds was transferred to the operating theatre. At laparotomy, a grade 3 transfixing (through and through) bilobar hepatic wound was discovered with active hemorrhage. Unfortunately, no suitable balloon catheters were available, so, as an alternative, tamponade of the wound tract was successfully achieved using a tubular omental patch. Discussion: Omental patches are commonly used in the management of perforated duodenal ulcers and have been used to prevent recurrence following hepatic cyst de-roofing. To the authors’ knowledge, this is the first description of this technique for the management of penetrating bilobar transfixing hepatic injury. Conclusion: A tubular omental patch may be used to achieve tamponade of deep wounds in penetrating hepatic trauma. This could be a particularly useful technique in resource-poor environments, or where a suitable balloon catheter is otherwise unavailable.

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