Analysis of risk factors cotnributing to releak in duodenal ulcer perforation: experience of surgical closure by Graham's patch

ABSTRACT

Free perforation of peptic ulcer into the general peritoneal cavity is a catastrophic event. Although laparoscopic approach has been successfully used for its management, primary closure of the perforation using an omental patch [Grahm's patch] is the immediate alterative. This study was planned to analyse risk factors, which could predict releak following Grahm's patch closure. This study was carried out for five years from April 2003 to March 2008, at department of surgery Muhammad Medical College Mirpurkhas. All patients undergoing surgery for perforated duodenal ulcer were included in the study. 53 patients underwent Grahm's Patch Closure. 6 patients developed releakage post operatively. Therefore two groups were made. Patients with releak were kept in case group [n=6] and the patients with no leak [n=47] were included in control group. In this study all patients were assessed for age, pulse rate, systolic blood pressure, hemoglobin and serum Protein / albumin, total leukocyte count [TLC] on arrival, delay in arrival since sign and symptom [probable] of perforation and size of perforation on operation were also documented. Age greater than 50 years [p=0.05], pulse greater than 110/min [p=0.22], systolic blood pressure less then 90mmHg [p=0.02l], hemoglobin less than 10gm% [p=0.25], serum albumin less than 2.5gm% [p=0.018], delay in arrival for more then 36 hour [p=0.00017], and size of proportion greater then 5mm in it maximum dimension were identified as risk factor for releak. Delay in arrival was the single most significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer