Stomach: Perforation Patching

Perforation Patching

Omental (Graham) Patch

  • Omentum Sewn Over Perforation
  • Procedure:
    • Mobilize a Well-Vascularized & Tension-Free Pedicle of Omentum
    • Place Interrupted Sutures on Opposite Sides of the Perforation Through Healthy Tissue
      • Leave Untied
    • Lay Omental Flap Over the Perforation
    • Gently Tie Down the Sutures Over the Omentum
    • Test for Air Leak
  • Do Not Repair the Primary Defect – Friable Tissue May Tear or Cause Stricture

Serosal (Thal) Patch

  • Serosa of a Jejunal Loop Sewn Over Perforation
  • Used if Omental Graham Patch Not Possible
  • Procedure:
    • Mobilize a Loop of Jejunum to the Defect
    • Suture Jejunal Serosa to Cover the Defect

Omental Patch 1

References

  1. Maghsoudi H, Ghaffari A. Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer. Saudi J Gastroenterol. 2011 Mar-Apr;17(2):124-8. (License: CC BY-2.0)