Postoperative Management of Graham Omental Patch Repair for Duodenal Ulcer Perforation

Immediate Postoperative Medical Management

• The American College of Surgeons recommends that all patients who undergo Graham omental patch repair for perforated duodenal ulcer must receive H. pylori eradication therapy with triple therapy and strict avoidance of NSAIDs and steroids postoperatively 1
• All patients require H. pylori testing if not performed preoperatively, as H. pylori infection is present in the majority of duodenal ulcer perforations 1

Strict Risk Factor Modification

• Absolute avoidance of NSAIDs is non-negotiable as NSAIDs are independently associated with mortality in perforated peptic ulcer patients and represent one of the strongest risk factors for perforation 1
• Avoid corticosteroids when possible, as steroids are associated with increased mortality risk and perforation 1, 2
• Mandatory smoking cessation is recommended, as smoking is a key predisposing factor for peptic ulcer disease and perforation 1, 2

Postoperative Surgical Care Considerations

• No routine physical activity restrictions are necessary after successful omental patch repair 1

Special Considerations for Bariatric Surgery Patients

• If the patient has history of bariatric surgery, assess for gastro-gastric fistula during repair, as this increases marginal ulcer recurrence risk 2
• Evaluate jejuno-jejunostomy for stricture or obstruction, as gastric remnant perforation may be secondary to back pressure 2, 3