Graham's Patch Versus Modified Graham's Patch in the Management of Perforated Duodenal Ulcer

Perforation of a duodenal ulcer is a severe complication of peptic ulcer disease that requires prompt resuscitation and appropriate surgical intervention to minimize morbidity and mortality. This study aimed to compare the outcomes and complications of Graham's patch versus modified Graham's patch repair in patients with perforated duodenal ulcers admitted to a tertiary care hospital in Bangladesh.

This comparative observational study was conducted in the Department of Surgery at Dhaka Medical College Hospital (DMCH) in Dhaka, Bangladesh, over a six-month period in 2018. Patients diagnosed with duodenal ulcer perforation were selected based on pre-defined inclusion criteria. Informed written consent was obtained from all participants prior to enrollment. A total of 60 patients (30 in each group) were included using a systematic sampling method. Data on post-operative outcomes and complications, such as leakage and wound infection, were collected using a pre-designed data sheet. Data analysis was performed using IBM SPSS Statistics for Windows, V. 24.0 (IBM Corp., Armonk, NY, USA).

The study included 60 participants with a mean age of 34.22±8.59 years (range: 16-53 years) and a male-to-female ratio of 2:1. In the Graham's patch group, 90% of patients had pus in the intraperitoneal cavity, compared to 67% in the modified Graham's patch group. Wound infection and post-operative fever were the most common complications observed in both groups, with no statistically significant differences (p=0.59; p=0.78). The average hospital stay was six days for the Graham's patch group and eight days for the modified Graham's patch group, also showing no significant difference between the groups (p=0.145).

This study compared the short-term outcomes of traditional versus modified Graham's patch repairs for perforated duodenal ulcers and found no significant differences in post-operative complications or hospital stay. Both techniques were safe and effective, allowing surgeons to choose based on experience and intra-operative factors, with the modified patch potentially offering easier handling for certain cases. However, due to limitations like small sample size and short follow-up, larger multi-center trials are needed to better assess long-term outcomes and guide surgical practice.