Omentopexy versus falciformopexy for peptic ulcer perforation

Area of Science:

• Gastroenterology
• Surgical Techniques
• Abdominal Surgery

Background:

• Peptic ulcer perforation (PUP) is commonly treated with omentopexy.
• Previous omentum resection presents technical challenges for omentopexy.
• Falciform ligament use for PUP is an alternative technique.

Purpose of the Study:

• To compare the outcomes of falciformopexy and omentopexy for peptic ulcer perforation (PUP).
• To evaluate the efficacy and safety of falciformopexy as an alternative to omentopexy.

Main Methods:

• Retrospective study of 303 patients treated for PUP between 1999 and 2018.
• Exclusion of patients with malignancy, gastric resection, definitive ulcer surgery, laparoscopic surgery, and nonoperative treatment.
• Comparison of open omentopexy versus falciformopexy based on surgeon's choice, analyzing intraoperative and postoperative outcomes.

Main Results:

• Similar demographics between falciformopexy (n=46) and omentopexy (n=243) groups, with lower ASA scores in the falciformopexy group.
• No significant differences in ulcer characteristics, operation duration, general postoperative morbidity, or mortality.
• Higher incidence of pexia failure in falciformopexy (8.7%) compared to omentopexy (2.6%), and more frequent atelectasis in the omentopexy group.

Conclusions:

• Falciformopexy serves as an alternative for PUP repair when omentum is not usable.
• Falciformopexy is not demonstrably superior to omentopexy for PUP repair.
• Choice between techniques depends on omental availability and surgeon preference, considering specific complication risks.