The Jejunal Serosal Patch Procedure: A Successful Technique for Managing Difficult Peptic Ulcer Perforation

Bekele, Abebe; Kassa, Seyoum; Taye, Mulat

doi:10.4314/ecajs.v21i3.11

Cited by 6 publications

(4 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is consistent with several other studies done locally and in Africa which found a variable male predominance, 7.2, 6.6, 1.3 and 9 times in Black Lion Hospital (BLH), Zewditu Memorial Hospital (ZMH), Tanzanian and Nigerian studies respectively (5,6,7,8). However this is contrary to the common depiction in western series as a disease of the elderly female (9).…”

Section: Discussioncontrasting

confidence: 70%

Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study

Teshome

Birega

Taddese

2020

Ethiop J Health Sci

View full text Add to dashboard Cite

BACKGROUND: Peptic ulcer perforation is one of the two major acute complications of peptic ulcer disease with significant morbidity and mortality.METHODS: Institution based retrospective review was done to determine patient presentation, management and postoperative complications of perforated peptic ulcer disease (PPUD) at a tertiary hospital in Addis Ababa, Ethiopia. Patients operated on from January 2013 to December 2017 were included. Univalent analysis was used to determine the influence of patient and operative events on postoperative outcomes.RESULT: Totally, 136 patients were studied. Males outnumbered females by a ratio of 5.5:1. The mean age of patients was 36.05±16.56 years. Seventy-one (52.2%) patients presented after twenty-four hours of onset of symptoms. Most perforations were located on the first part of the duodenum (117,86%). There were 73 postoperative complications recorded in 31(22.8%) patients. Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity (P<0.05). Nine (6.6%) patients died at the hospital. Mortality was significantly associated with old age, comorbid illness, tachycardia, and development of post-operative complications (P<0.05). The postoperative hospital stay of the patients with complications was 18.6 ± 14.7 days which was significantly higher than that of patients without complication 6.7±2.7days (P=0.001).CONCLUSION: Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity. Old age, comorbid illness, tachycardia and development of post-operative complications were found to increase the risk of mortality.

show abstract

Section: Discussioncontrasting

confidence: 70%

Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study

Teshome

Birega

Taddese

2020

Ethiop J Health Sci

View full text Add to dashboard Cite

show abstract

“…10 Jejunal serosal patch is commonly used in the treatment of duodenal ulcer perforation, where it has eliminated the need for synthetic material and aids by providing a layer of protection. 6 Research supports the use of pyloric exclusion and jejunal serosal patch in select complex cases with a reduction in morbidity noted, but queries the benefit of its use in simpler cases because it may prolong hospital stay and confer no survival or outcome benefit. 11 – 13 There are multiple ways to establish nutrition following duodenal trauma and pyloric exclusion.…”

Section: Discussionmentioning

confidence: 97%

“…For more complex injuries, especially after blunt trauma where the injury has a tendency to evolve over a number of days with delayed leakage of repair (grade III–V), management remains divided. 3 – 5 One technique described is the jejunal serosal patch, which reinforces the primary repair by offering an additional layer of protection 6 to mitigate against leakage. Pyloric exclusion is another technique described after severe duodenal injury, as a temporary measure to prevent fluids entering the lumen of the duodenum from the stomach, thereby enabling primary repair without resection and, in theory, reducing leakage from the primary repair.…”

Section: Introductionmentioning

confidence: 99%

Use of jejunal serosal patch and pyloric exclusion in the management of complex duodenal injury

Alsaadi,

Low,

Osman

et al. 2024

annals

View full text Add to dashboard Cite

Background Duodenal injuries are relatively rare but remain a management challenge with a high incidence of postoperative complications. Guidelines from the World Society of Emergency Surgery and American Association for the Surgery of Trauma favour a primary repair for less-complex injuries, but the management of more complex duodenal trauma remains controversial with varying techniques supported, including pyloric exclusion, omental or jejunal patch closure, gastrojejunostomy and pancreatoduodenectomy. We describe the techniques used in one case of complex duodenal trauma. Technique The duodenum is approached via a standard laparotomy with Kocherisation. Primary repair of the duodenal perforations is performed using a 3/0 polydioxanone suture (PDS), followed by mobilisation of a loop of mid-jejunum against the area of duodenal trauma over the primary repair as a jejunal serosal patch. The antimesenteric jejunal serosal border is sutured to the serosa of the duodenum (serosa only) using a 3/0 PDS. Pyloric exclusion is then performed through an anterior gastrostomy, to control the volume of gastric juice entering the duodenum. The pylorus is sutured closed using an absorbable suture followed by closure of the anterior gastrostomy using a GIA stapling device.

show abstract

“…A review of current literature suggests a myriad of surgical techniques but no perfect solution. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy [25][26][27][28][29][30][31]. Many of the techniques are complex and require a high degree of surgical expertise, which may not be available in the emergency setting.…”

Section: Conclusion -Discussion and Review Of Literaturementioning

confidence: 99%

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Lee¹,

Shulin²,

Li³

et al. 2020

SCR

View full text Add to dashboard Cite

Background: Despite advances in the medical management of peptic ulcer disease, duodenal ulcer (DU) perforation remains a common surgical emergency. Most DU perforations are small and can be managed with omental patch repair. However, occasionally the surgeon may encounter a giant perforation not amenable to this. Giant DU perforations are defined as > 2cm. They are associated with high leak rates and mortality. Prognosis in elderly patients are particularly poor because of advanced age and comorbidities. Furthermore, there are no specific recommendations for their management despite a variety of repair techniques being described. Here, we aim to describe a novel technique used to treat such patients, especially those of advanced age, in our institution and to review the current literature. Case presentation: Four patients with giant DU perforation underwent emergency laparotomy and repair with our duodenojejunostomy technique at our hospital. Post-operatively, patients were monitored clinically and radiologically and discharged when well and tolerating diet. The mean age of the patients was 67 years with an equal gender distribution. The average Charlson Comorbidity Index (CCI) score was 3 (moderately severe). All presented with peritonitis and two had concomitant bleeding. There were two anterior and two posterior ulcers. One was a revision repair after a leak post laparoscopic omental patch repair for the initial perforation. In all cases, the duodenojejunostomy repair technique was used. Post-operative recovery was uneventful for all except one who developed pneumonia. In particular; there were no anastomotic leaks, intra-abdominal collections, gastric outlet obstructions or mortalities. Conclusion: Giant DU perforation remains a challenge to the general surgeon, particularly so in elderly patients with multiple comorbids. A review of the current literature suggests a myriad of surgical techniques but no perfect solution. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy. Here, we propose that isolated duodenojejunostomy can be a quick, safe and novel solution that ensures definitive repair of giant ulcer perforation in a single setting in the high-risk patient.

show abstract

The Jejunal Serosal Patch Procedure: A Successful Technique for Managing Difficult Peptic Ulcer Perforation

Cited by 6 publications

References 1 publication

Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study

Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study

Use of jejunal serosal patch and pyloric exclusion in the management of complex duodenal injury

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Contact Info

Product

Resources

About