The Use of Abdominal Drains in Perforated Peptic Ulcer

Abstract

Background: Peptic ulcer disease's second-most common complication is perforation, constituting a surgical emergency with approximately 30% short-term mortality and 50% morbidity. Patients with untreated duodenal ulceration face a 10% lifetime risk of perforation, reduced with initial ulcer healing. The Graham omental patch technique involves leaving two tube drains, one in Morrison's pouch and one in the pelvis. This study aims to elucidate the effects of routine abdominal drain use on postoperative outcomes after closure surgery for peptic ulcer perforation, assessing the efficacy and safety of this approach.Methods: A prospective observational cross-sectional study enrolled 60 patients conducted between December 2021 and January 2023, with perforated peptic ulcers who underwent repair using the Graham omental patch technique. Two tube drains were utilized. Postoperative follow-up and complication observation involved categorizing patients into two groups (A and B) based on the presence or absence of drain-related complications.Results:Drain related complications were seen in 40% of study subjects, most common of which was Drain site pain followed by Restriction of mobility and Peri tubal discharge/leakage with skin excoriation. Late presentation (>24 hours), Gastric ulceration, perforations larger than 1 cm and peritoneal spillage of more than 1000 ml significantly influenced the outcome and rate of development of post operative drain related complications in patients operated for perforation peptic ulcer. Conclusion:All drains carry a risk of significant postoperative complications. In the setting of good surgical technique and the presence of sufficient equipment for the detection of intra-abdominal complications postoperatively like ultrasonography and CT scan, abdominal drains should be used rationally.