Graham Patch Repair for Perforated Ulcer

Procedure Snapshot

• Indication: Acute gastric/duodenal perforation from ulcer.
• Expected duration: ___
• Special instruments: Omentum pedicle, 3-0 silk sutures, lap set.

Step Workflow

1. Midline laparotomy; suction contamination.
2. Identify perforation (anterior duodenal > gastric).
3. Place three seromuscular sutures around defect.
4. Lay well-vascularized omental patch over defect.
5. Tie sutures to secure patch.
6. Irrigate and drain if gross contamination.

Key Pimp Questions

• Q: Name the triad for perforated ulcer?
  A: Sudden pain, rigid abdomen, free air under diaphragm.
• Q: Why laparoscopic preferred when feasible?
  A: Less pain, faster recovery (PMID 32404774).

Critical Anatomy

• Landmarks: Anterior duodenal bulb, omentum.
• Danger zones: GDA posterior to duodenum.

Informed Consent Highlights

• Risks: Leak __, abscess __, bleeding ___.

Post-op Considerations

• PPI and H. pylori eradication.
• Contrast study if concern for leak before PO.

References

• Chassin’s, Ulcer section.
• Clinical Scenarios, Upper GI.
• Bertleff 2020 (PMID 32404774).