Omentopexy versus falciformopexy for peptic ulcer perforation

BACKGROUND: Open or laparoscopic Graham’s omentopexy is frequently used in the treatment of peptic ulcer perforation (PUP). The technical difficulty of applying the omental plug, especially in patients with previous omentum resection, has led to the use of falciform ligament for the PUP, and some studies have reported that PUP may even be a more advantageous technique than omentopexy. Here, in this study, we aimed to compare the retrospective results of patients who underwent falciformopexy or omentopexy for PUP.
METHODS: Between 1999 and 2018, 303 patients who were followed-up and treated for PUP were included in this study. Patients who had malignancy, gastric resection, definitive ulcer surgery, laparoscopic surgery and nonoperative treatment were excluded from this study. In the remaining patients, either open ometopexy or falciformopexy were applied based on the surgeon’s choice. These two techniques were compared for intraoperative and postoperative outcomes.
RESULTS: Falciformopexy (n=46) and omentopexy (n=243) groups had similar demographics, but ASA scores were lower in the falciformopexy group. For ulcer size and localization, duration of operation, no difference was found between the groups. There was no significant difference between the groups concerning general postoperative morbidity and mortality. However, atelectasis was more frequently observed in the omentopexy group, whereas the pexia failure was more frequent in the falciformopexy group (2.6% and 8.7%, p=0.04).
CONCLUSION: Falciformopexy is an alternative technique that can be used in situations where it is not possible to use the omentum. Falciformopexy is not superior to omentopexy for the repair of the PUP.

Peptik ülser perforasyonunda omentopeksi ile falsiformopeksinin karþýlaþtýrýlmasý

AMAÇ: Peptik ülser perforasyonunda (PÜP) açýk veya laparoskopik Graham omentopeksi sýklýkla uygulanan tedavi þeklidir. Özellikle omentum rezeksiyon öyküsü olan hastalarda uygulanmanýn teknik zorluðu, PÜP’de falsiform ligament kullanýmýna yol açmýþ olup bazý çalýþmalarda omentopeksi’den daha avantajlý bir teknik olabileceði bildirilmiþtir. Bu çalýþmada, PÜP onarýmýnda falsiformopeksi veya omentopeksi uygulanan hastalarýmýzýn geriye dönük sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: 1999–2018 yýllarý arasýnda PÜP nedeniyle takip ve tedavi edilen 303 hasta çalýþmaya alýndý. Malignite, gastrik rezeksiyon, definitif ülser cerrahisi, laparoskopik cerrahi ve ameliyat dýþý tedavi alan hastalar çalýþma dýþý býrakýldý. Kalan hastalara ometopeksi veya falsiformopeksi uygulandý. Bu iki teknik ameliyatta ve amaliyat sonrasý sonuçlar açýsýndan karþýlaþtýrýldý.
BULGULAR: Falsiformopeksi (n=46) ve omentopeksi (n=243) gruplarý benzer demografik özelliklere sahipti, ancak ASA skorlarý falsiformopeksi grubunda daha düþüktü. Ülser boyutu ve lokalizasyonu, operasyon süresi açýsýndan gruplar arasýnda fark saptanmadý. Genel postoperatif morbidite ve mortalite açýsýndan gruplar arasýnda anlamlý fark yoktu. Bununla birlikte, omentopeksi grubunda atelektazi daha sýk görülürken, peksi baþarýsýzlýðý falsiformopeksi grubunda daha sýktý (%2.6 ve %8.7, p=0.04).
TARTIÞMA: Falsiformopeksi, omentumu kullanmanýn mümkün olmadýðý durumlarda kullanýlabilecek alternatif bir tekniktir. PÜP onarýmý için omentopeksi’den daha üstün deðildir.