Postoperative Complications of Graham Omentopexy for Duodenal Ulcer Perforation

Abstract

Duodenal ulcer perforation is a life-threatening surgical emergency requiring prompt intervention. Graham’s omentopexy remains a widely practiced and effective surgical technique for closure of perforated duodenal ulcers. However, postoperative complications continue to contribute to morbidity, particularly in resource-limited settings. Objective: To determine the postoperative complications of Graham’s omentopexy in patients with duodenal ulcer perforation at Lady Reading Hospital, Peshawar. Methods: This descriptive study was conducted at Lady Reading Hospital–MTI, Peshawar, from May 24, 2024, to November 24, 2024. A total of 100 patients aged 18–65 years, of either gender, presenting with duodenal ulcer perforation were enrolled. Diagnosis was established clinically and confirmed by computed tomography (CT) scan. Patients who were pregnant or lactating, or had a prior history of abdominal surgery or radiation therapy, were excluded. All patients underwent Graham’s omentopexy. Postoperative complications, including wound infection, bile leak, paralytic ileus, intra-abdominal abscess, pneumonia, and septic shock, were assessed. Data were analyzed using SPSS version 27. Complications were reported as frequencies and percentages, and 95% confidence intervals (CI) were calculated. Results: The mean age of the study population was 44.69 ± 13.47 years, with 63 (63.0%) male patients. Risk factors included Helicobacter pylori infection in 55 (55.0%) patients and non-steroidal anti-inflammatory drug (NSAID) use in 42 (42.0%). The majority of perforations were ≤1 cm in size (75%). Postoperative complications included wound infection in 20 (20.0%) patients, paralytic ileus in 8 (8.0%), pneumonia in 7 (7.0%), intra-abdominal abscess in 6 (6.0%), bile leak in 5 (5.0%), and septic shock in 4 (4.0%). Conclusion: Graham’s omentopexy is a safe and effective surgical procedure for the management of duodenal ulcer perforation. Wound infection was the most common postoperative complication, followed by paralytic ileus and pneumonia. Early diagnosis and timely surgical intervention may further improve clinical outcomes.