Authors: Samir Johna Moshe Schein
Publish Date: 2013/08/28
Volume: 37, Issue: 11, Pages: 2546-2547
Abstract
In spite of the effective modern medical management of peptic ulcer disease surgeons are still called on to treat perforated ulcers for which repair with omental patch—in open surgery or laparoscopy—is the standard of care Omentopexy of a perforated ulcer if correctly done and tested for its water tightness is very unlikely to leak But in the “real world” as shown in the study by Gupta et al published in this issue of World Journal of Surgery 1 such leaks do occur WhyIt is easy to “blame” the leak on the patient attributing it to factors such as advanced age hemodynamic instability sepsis malnutrition and so forth but we believe that in most duodenal leaks that develop after closure of a perforated ulcer described in series coming mostly from the developing world the lack of a properly performed omentopexy is the overriding factor Some surgeons misunderstand what omentopexy should be they first sutureclose the perforation and only then cover the suture line
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