Omental (Graham) Patch Periprocedural Care

Updated: Sep 25, 2019
  • Author: Razvan C Opreanu, MD, MS; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Preprocedural Planning

Resuscitation of the patient plays a crucial role in the management of a patient with perforated duodenal ulcer. An increase in preload with reduction of the afterload and improvement of stroke output is ideal. This also allows the patient to compensate for the reduction in preload engendered by positive-pressure ventilation during and often after surgery.

Resuscitation is usually facilitated by using a central venous catheter to measure central venous pressure (CVP). This allows the surgeon to resuscitate the patient more aggressively toward a prechosen CVP goal.

Monitoring of urinary output and lactic acid also provides important insights into the preoperative resuscitation of a hemodynamically labile patient.

Consideration should be given to placement of an arterial catheter for hemodynamic monitoring and prompt arterial blood gas measurements based upon the degree of shock present. This can be established preoperatively during fluid resuscitation or by the anesthesia team after induction to allow timely surgical intervention. Resuscitation should be expeditious because a delay in operation is associated with increased morbidity and mortality.

Preoperative decompression of the stomach using a nasogastric tube limits further spillage of gastrointestinal (GI) secretions into the peritoneum during the resuscitation period.

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Patient Preparation

Broad-spectrum antibiotic coverage is initiated preoperatively and continued postoperatively for a duration dependent on the patient’s clinical status and the degree of intra-abdominal spillage.

General anesthesia is used for either open or laparoscopic omental patch repair of perforated duodenal ulcer.

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