Omental Patch Repair of Large Perforated Peptic Ulcers ≥25 Mm is Associated with Higher Leak Rate

Overview

Journal J Clin Transl Res

Date 2022 Jan 6

PMID 34988327

Citations 1

Authors

Yi Liang Wang

Xue Wei Chan

Kai Siang Chan

Vishal G Shelat

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Omental patch repair is the present gold-standard technique for patients with perforated peptic ulcers (PPUs). Data are lacking regarding the safe ulcer size for omental patch repair leak (OPL). We analyze our experience in managing PPU to identify an ulcer size cut-off for predicting OPL.

Methods: Patients who had undergone omental patch repair for PPU between Jan 2004 and Apr 2016 were included. Demographic data, the American Society of Anesthesiologists score, ulcer size, operative approach, post-operative complications, and length of stay were recorded. OPL, intra-abdominal collection, repeat surgery, and 30-day mortality were recorded. The relationship between ulcer size, pre-operative characteristics, and OPL were investigated with univariate and multivariate logistic regression. Receiver operating characteristic curve analysis derived the ulcer size cut-off to predict OPL. In addition, we analyzed if ulcer size predicted mortality or malignancy.

Results: Six hundred and ninety patients with a mean age of 55.1 years (range 16-94) were managed for PPU during the study period. Free air on X-ray was evident in 417 (60.4%) patients. Mean ulcer size was 7.8 mm (range 1-50). OPL occurred in 15 patients (2.2%) and 30-day mortality was 7.4% (=51). Multivariate analysis found ulcer size increase of 10 mm (OR 3.30, 95% CI 1.81-6.02, <0.001) predicted increased risk of OPL. At 25 mm cut-off, sensitivity was 26.7%, specificity was 97.2%, positive likelihood ratio was 9.47, and negative likelihood ratio was 0.76 for OPL.

Conclusion: Ulcer size increase in 10 mm increases leak rate by 3.3 times. Ulcer size ≥25 mm predicts OPL.

Relevance For Patients: Increased risk of OPL for ≥25 mm warrants need for close post-operative monitoring and lowers threshold for investigations in event of clinical deterioration. Decision for omental patch repair versus gastrectomy however should not be based on ulcer size alone.

Citing Articles

Advances and results in omental patch repair of gastrointestinal perforations: A narrative review.

Velasco-Velasco F, Llerena-Velastegui J Surg Pract Sci. 2025; 19():100261.

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Excisional biopsy of perforated gastric ulcer: mandatory or potentially harmful?.

Koca F, Koch C, Schulze F, Pession U, Bechstein W, Malkomes P Langenbecks Arch Surg. 2024; 409(1):205.

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