Healing process in the early phase after the simple closure/omental patch for perforated duodenal ulcer: endoscopic direct evaluation

Objective

Although the simple closure/omental patch (SC) has been standard procedure for perforated duodenal ulcer (PDU) in most institutes in Japan, this procedure was originally performed for poor-risk patients. Basic evaluation concerning the SC has been insufficient and the SC has been performed based on only experience. Gastrointestinal endoscopic examination (GF) makes it possible to evaluate such fine structures. However, it is not known whether the early endoscopic examination after SC is safe or not. The aim of this study is to clarify the macroscopic findings of the healing process after the SC for PDU.

Materials and methods

We perform the SC for patients with PDU, without stenosis, and without prominent ulcer ridge. We start medication of H2-RA (or PPI) just after operation, and oral feeding 4–5 days after operation independent of postoperative GF. Eleven patients with PDU who were treated with the SC underwent postoperative GF at the 4th–16th postoperative day and the healing process was examined. We do not perform radiographic examination of leakage from anastomosis. All 11 patients were informed that we could be convinced of the healing process with some unknown risk.

Results

In three of 11 patients, GF findings showed an active stage and a healing stage. In two of them, the surgical technique was thought to be insufficient (the distance between the stitch and the edge of the ulcer was insufficient), and in the other patient postoperative GF was performed on the 4th postoperative day because of transfer to another minor hospital. The other eight patients showed a scar phase with good granulation and without exposure of stitches. Iatrogenic perforation, bleeding, and severe abdominal pain during or after postoperative GF was not seen in all cases.

Conclusion

Postoperative GF in the early phase after SC is useful and safe for evaluating the healing process of the SC for PDU. We can start oral intake 1 week after this surgical procedure.