Perforation closure with omental patch - Khobragade Multispeciality Hospital

What is Perforation Closure with Omental Patch?

Perforation closure with an omental patch, commonly known as Graham’s patch repair, is a surgical procedure used to treat a perforated peptic ulcer or gastrointestinal (GI) perforation. In this condition, a hole develops in the wall of the stomach or intestine, leading to leakage of contents into the abdominal cavity. This is a life-threatening emergency that requires immediate surgical intervention.

The omental patch technique involves using a part of the omentum (a fatty tissue layer that covers and supports abdominal organs) to cover and seal the perforation. This not only physically closes the hole but also promotes healing and prevents further leakage and infection.

Symptoms of Gastrointestinal Perforation

A GI perforation may present with sudden, intense symptoms such as:

Severe abdominal pain, often spreading across the abdomen
Fever and chills
Nausea and vomiting
Distension or bloating
Rigid or tender abdomen
Rapid heartbeat and low blood pressure
Signs of shock in severe cases

These symptoms typically occur suddenly and worsen quickly. Emergency medical attention is crucial.

Procedure: Omental Patch Repair

Preoperative Evaluation:

Diagnosis is confirmed using X-rays, CT scans, and blood tests
Stabilization with IV fluids, antibiotics, and pain management
Nasogastric tube insertion to decompress the stomach

Surgical Steps:

A laparotomy (open surgery) or laparoscopy (minimally invasive surgery) is performed.
The perforation site is identified—commonly in the stomach or duodenum.
A healthy segment of omentum is mobilized.
The omental patch is secured over the perforation using sutures.
The abdominal cavity is cleaned (peritoneal lavage) to prevent infection.
Drains may be placed, and the abdomen is closed.

Postoperative Care:

Monitoring in the ICU or surgical ward
Antibiotic therapy
Gradual return to oral feeding
Management of underlying causes like ulcers or infections

Prevention of Gastrointestinal Perforation

While some causes of GI perforation may be sudden and unavoidable, many cases can be prevented by managing underlying risk factors:

Avoid prolonged use of NSAIDs or steroids
Limit alcohol and tobacco use
Treat Helicobacter pylori infections promptly
Manage peptic ulcer disease effectively
Adopt a balanced, ulcer-friendly diet
Seek early treatment for abdominal symptoms

Benefits of Omental Patch Surgery

Life-saving procedure in cases of perforated ulcers
Effective sealing of perforation with reduced leakage
Promotes healing due to the omentum’s rich blood supply
Reduces risk of peritonitis and sepsis
Minimally invasive options available in selected patients
Faster recovery and reduced hospital stay with laparoscopic approach

Types of Omental Patch Techniques

There are a few variations of the omental patch method, depending on the location and size of the perforation:

Graham’s Omental Patch: The classic method, commonly used for duodenal ulcers.
Pedicled Omental Patch: Uses a vascularized omental flap for better blood supply.
Free Omental Graft: Small pieces of omentum are sutured to cover larger or irregular defects.
Laparoscopic Omental Patch Repair: A minimally invasive alternative, suitable for stable patients with small perforations.