FREQUENCY OF WOUND INFECTION AMONG PATIENTS UNDERGOING GRAHAM'S OMENTOPEXY IN THE MANAGEMENT OF PERFORATED DUODENAL ULCER

F SHAH; AU HAQ

doi:10.54112/pjicm.v5i02.123

Authors

F SHAH Department of Surgery, Saidu Group of Teaching Hospital, Swat, Pakistan
AU HAQ Department of Surgery, Saidu Group of Teaching Hospital, Swat, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.123

Keywords:

Keywords: Graham’s Omentopexy, Perforated Duodenal Ulcer, Wound Infection, Surgical Complications, Risk Factors

Abstract

Background: A Perforated duodenal ulcer is a surgical emergency associated with significant morbidity, including postoperative wound infection. Graham's omentopexy remains the standard repair technique, but postoperative infection rates vary across populations. Objective: To determine the frequency of wound infection among patients undergoing Graham's omentopexy for the management of perforated duodenal ulcer. Study Design: Cross-sectional study. Setting: Department of Surgery, Saidu Group of Teaching Hospitals, Swat, Pakistan. Duration of Study: 11 October 2024 to 11 April 2025. Methods: Eighty-five patients aged 18–75 years with clinically and radiologically confirmed perforated duodenal ulcers were included. All underwent Graham's omentopexy. Wound infection was assessed on the 7th postoperative day based on clinical criteria. Data on age, gender, diabetes, and hypertension status were collected. Descriptive statistics were calculated using SPSS version 25. Results: The mean age was 40.68 ± 15.99 years. Of the total, 55.3% were male and 44.7% were female. Diabetes mellitus was present in 20% and hypertension in 29.4% of patients. The overall wound infection rate was 23.5%. Conclusion: Wound infection occurred in nearly one-fourth of patients undergoing Graham's omentopexy for perforated duodenal ulcer. These findings highlight the need for targeted infection prevention strategies in this high-risk surgical population.

References

Sverdén E, Agréus L, Dunn JM, Lagergren J. Peptic ulcer disease. Br Med J. 2019;367. https://doi.org/10.1136/bmj.l5495

Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic ulcer disease. Lancet. 2024;404(10447):68-81. https://doi.org/10.1016/S0140-6736(24)00155-7

Weledji EP. An overview of gastroduodenal perforation. Front Surg. 2020;7:573901. https://doi.org/10.3389/fsurg.2020.573901

Clinch D, Damaskos D, Di Marzo F, Di Saverio S. Duodenal ulcer perforation: A systematic literature review and narrative description of surgical techniques used to treat large duodenal defects. J Trauma Acute Care Surg. 2021;91(4):748-58. https://doi.org/10.1097/TA.0000000000003357

Shen Q, Liu T, Wang S, Wang L, Wang D. Experience in diagnosis and treatment of duodenal ulcer perforation in children. BMC Paediatrics. 2023;23(1):144. https://doi.org/10.1186/s12887-023-03957-8

Lanas A, Chan FK. Peptic ulcer disease. Lancet. 2017;390(10094):613-24. https://doi.org/10.1016/S0140-6736(16)32404-7

Cellan-Jones C. A rapid method of treatment in perforated duodenal ulcer. Br Med J. 1929;1(3571):1076. https://doi.org/10.1136/bmj.1.3571.1076

Khare AK, Patel KP, Chopra AK, Goyal P, Paliwal A, Baindur AJ, et al. Graham's patch omentopexy versus modified Graham’s patch omentopexy in duodenal perforation – A comparative study. Asian J Med Sci. 2024;15(8):156-61. https://doi.org/10.3126/ajms.v15i8.58487

Xue DYB, Mohan R, Shelat VG. Perforated peptic ulcer. In: Textbook of Emergency General Surgery. Springer; 2023. p. 1067-84. https://doi.org/10.1007/978-3-031-22599-4_72

Satapathy MC, Dash D, Panda C. Modified Grahams′ omentopexy in acute perforation of first part of duodenum: A tertiary level experience in South India. Saudi Surg J. 2013;1(2):33-6. https://doi.org/10.4103/2320-3846.125032

Abouelazayem M, Jain R, Wilson MS, Martinino A, Balasubaramaniam V, Biffl W, et al. Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study. Surg Endosc. 2024;38(8):4402-14. https://doi.org/10.1007/s00464-024-10881-0

Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: A review. JAMA. 2023;329(3):244-52. https://doi.org/10.1001/jama.2022.24075

Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59-74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029

Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234-7. https://doi.org/10.1089/sur.2012.131

Abdallah HA, Abd-El-Aal AS. Comparative study between Graham’s omentopexy and modified-Graham’s omentopexy in treatment of perforated duodenal ulcers. Egypt J Surg. 2018;37(4):485-9. https://doi.org/10.4103/ejs.ejs_61_18

Khan MA, Khan WY, Khan MU, Hussain E, Khan S, Usman SZ. Outcome of Graham patch omentopexy in the management of perforated duodenal ulcer. Biol Clin Sci Res J. 2024:1123. https://doi.org/10.54112/bcsrv4i2.1123

Waqar HA, Lateef A, Riaz T, Farrukh U, Fatima T, Chaudhry SAA. Frequency of surgical site infection between laparoscopic Graham’s omentopexy and open Graham’s omentopexy after duodenal ulcer perforation. Prof Med J. 2024;31(9):1313-7. https://doi.org/10.29309/TPMJ/2024.31.09.8262

Sharif G, Noor G, Sardar N, Iqbal Z, Room SE, Wahab A. Frequency of common early complications following omentopexy as primary repair in perforated duodenal ulcer. J F J M C. 2015;9(1):31-5. Available from: https://www.jfjmu.com/index.php/ojs/article/view/113

Dogra P, Kaushik R, Singh S, Bhardwaj S. Risk factors for leak after omentopexy for duodenal ulcer perforations. Eur J Trauma Emerg Surg. 2023;49(2):1163-7. https://doi.org/10.1007/s00068-022-02058-y

Ali R, Pathan AH, Langah IA, Khan MGA, Soomro IA, Khatti SN. Clinical presentation, postoperative complications and risk factors of duodenal leakage after Graham omentopexy for duodenal ulcer perforation. J Popul Ther Clin Pharmacol. 2024;31(7):239-43. Available from: https://www.jsp.org.pk/index.php/jsp/article/view/362