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Background/Objectives: Primary repair of duodenal perforations with the omental patch technique has re-emerged as the mainstay of treatment of this widely-prevalent condition, especially in our country. We have prospectively studied factors affecting outcome (morbidity, mortality) of duodenal ulcer perforations treated by omental patch technique, and have also attempted to study the efficacy of contemporary scoring systems (Haceteppe, APACHE II, Mannheim Peritonitis Index, Jabalpur score) in predicting outcome. Methods: One hundred consecutive patients of non-traumatic duodenal ulcer perforations (NTDUP) over a 2-year period were recruited for this prospective study at a tertiary care hospital in Delhi, India. Clinical and laboratory data, and, outcome, were recorded; all patients were treated with omental patch repair. Results: In 100 patients, there were 97 male (mean age= 40.8 ± 14.2 years) and 3 female (mean age= 38.3 ± 12.6). Fourteen patients recovered completely, 86 had complications; of the latter five died. Age, serum creatinine, and perforation size were associated with unfavourable outcome (p=0.015, 0.000, 0.013 respectively; students t-test). Presence of hypotension, serum creatinine, perforationoperation interval (PO), and perforation size, were associated with mortality alone (p=0.000, 0.001, 0.001, 0.000 respectively; student’s t-test). Age, serum creatinine, PO, and perforation size had correlation with longer hospital stay (p=0.044, 0.005, 0.012, 0.003 respectively; Pearson’s coefficient). Using receiver operating characteristic (ROC) curves, only the APACHE II and the Jabalpur scoring systems accurately predicted poor outcome. Conclusions: Omental patch is a safe and effective method of closure of duodenal perforations. Other procedures may be combined if high-risk factors are identified, e.g., large perforation size. The Jabalpur score is a simple tool in large emergency rooms with limited facilities. Received: March 13, 2018; Accepted: April 06 2018; Published: April 10, 2018 *Corresponding author: Nitin Agarwal, Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi 110001, India, Email: drnitinagarwal76@gmail.com Symbiosis www.symbiosisonline.org www.symbiosisonlinepublishing.com Symbiosis Group * Corresponding author email: drnitinagarwal76@gmail.com Introduction The two most common causes of secondary peritonitis are small bowel and gastroduodenal perforation, especially in the developing world. In many studies, duodenal perforation is the most common cause [1-5]. At some point of time, omental patch repair of duodenal ulcer perforations was replaced by definitive acid-reduction procedures because of the high rates of recurrence. But with rapid and vast improvements in proton pump inhibitory agents, and, efficacious anti-Helicobacter pylori regimens, this may no longer be true [6-8]. Omental patch repair of duodenal ulcer perforation is both simpler than and as effective as definitive ulcer surgery in the emergency situation [9]. Perforations larger than 3 cms have also been reported to be successfully repaired with this technique [10]. All these considerations have led to the resurgence of this technique. Mortality due to ulcer perforation treated by simple closure and/or other methods is still around 10% [11-13]. Factors reported to affect mortality in duodenal ulcer perforations in other series are old age, co-morbidity, preoperative hypotension, large size of the perforation, delay in presentation, and, delay in operation [14-18]. This prospective study was designed to study the morbidity and mortality in patients with non-traumatic duodenal ulcer perforation (NTDUP) treated by omental patch repair at a tertiary care centre in north India, and to correlate clinical, laboratory, and, operative factors with outcome. The efficacy of contemporary scoring systems (Haceteppe, APACHE II, Mannheim Peritonitis Index, Jabalpur score) in predicting outcome in our patients was also assessed.

Omental Patch Repair for Duodenal Ulcer Perforation- Analysis of Factors Affecting Outcome: A Prospective Study