A COMPARATIVE STUDY OF CLOSURE OF DUODENAL PERFORATION BY OMENTOPLASTY VERSUS OMENTOPEXY

Abstract

Introduction: Duodenal perforation, a surgical emergency with a mortality rate of 4%-30% in Western countries, is often underreported in India. Peptic ulcer disease, caused by drugs and H. pylori infection, is the leading cause. Perforation sizes range from 3mm to over 3 cm, impacting prognosis. Mortality depends on size, age, and risk factors. The omentum is used in gastrointestinal surgery to promote fibrosis and prevent leakage. Aims: The study compares the success rate of omentoplasty and omentopexy in closing duodenal perforations, examining pre-operative, intra-operative, and post-operative outcomes, including age, sex, symptom duration, and complications. Methodology: The study compares omentoplasty and omentopexy procedures for treating giant peptic perforation in Emergency Exploratory Laparotomy patients aged 15-85, covering 64 patients from March 2022 to September 2023. Results: The study found no significant difference in age distribution between Omentopexy and Omentoplasty groups in duodenal perforations prevalence. Young patients had higher perforation rates, leading to postoperative complications. Males and females had higher complications. Early and late patients presented differently, with higher rates in Omentopexy and Omentoplasty. Discussion: Duodenal perforation is a major surgical emergency with mortality rates of 4-30% in Western countries. It's difficult to repair due to its complex anatomy. Techniques like Omentopexy and Omentoplasty have been developed, but common post-operative complications include infection, pneumonia, and incisional hernia. Patients over 50 years old have higher mortality rates, and delayed diagnosis and treatment contribute to higher morbidity. Conclusion: The study found that older age, delayed presentation, shock, and large perforations increase mortality risk. Omentopexy was found to be more effective in reducing postoperative complications and mortality.