First suggested for patients with perforated gastric ulcers in 1894,
1
omental patch closure of a perforated duodenal ulcer was popularized by Graham in
1937
2
and has remained a surgical mainstay. Over time and before the descriptions of Helicobacter pylori, H2-receptor antagonists, and proton-pump inhibitors, omental patch closure was one of
the 4 operations used to treat perforated gastroduodenal ulcers. These included gastrectomy
for perforated gastric ulcers and truncal vagotomy and pyloroplasty, truncal vagotomy
and resection, and proximal gastric vagotomy with omental patch closure for perforated
duodenal ulcers.
3
,
4
,
5
These “definitive” operations were used from the 1940s to the 1990s because of the
following problems or limitations of omental patch closure as follows: (1) technical
difficulties in patching gastric or large duodenal perforations; (2) early reperforation
or bleeding; (3) recurrent symptoms (73% of patients) postoperatively
5
; (4) late reperforation (9% of patients)
6
; and (5) a large number of reoperations (48% of patients).
7
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Published online: February 10, 2014
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