Omental patch

Dr. Ady Mulya

 Reference
• ZOLLINGER’S ATLAS OF SURGICAL OPERATIONS NINTH
EDITION
• Maingot’s Abdominal Operations
• The closure is reinforced with omentum by separating the long ends of the three
previously tied sutures and placing a small portion of omentum along the suture line.
• The ends of these sutures are loosely tied, anchoring the omentum over the site of
the ulcer (figure 3).
• The tissue may be so indurated that the ulcer cannot be closed successfully,
making it necessary to seal the perforation by anchoring omentum directly
over the ulcer.
In the presence of a perforated gastric ulcer, a small biopsy of the margin of the
perforation is taken because of the possibility of malignancy (figures 4 and 5).

The omentum may be anchored over the suture line (figure 6).
• By 5–6 years, symptomatic ulcer recurrence in patients with acute ulcer
perforationis similar to that for patients with chronic disease.
• Before the role of H. pylori was appreciated, simple omental closure of
duodenal perforation had not provided satisfactory long-term results; up to
80% of patients so treated had recurrent ulceration and 10% experienced
reperforation.
• Several investigators advocate omental patch closure alone with postoperative anti–
H. pylori therapy.37–41
• Omental patching can also be accomplished laparoscopically in select patients.42
• This approach rests upon three assumptions:
(1) that most perforated duodenal ulcers are caused by H. pylori;
(2) that the duodenal perforation is small enough that secure closure can be obtained;
and
(3) that further surgical therapy will be obviated by the effects of postoperative
antibiotic therapy and acid suppression.
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