Graham Patch
Date of Surgery -
Preop Diagnosis - perforated duodenal ulcer
Postop Diagnosis - same
Surgeon - Dr. Luk / D. Tran
Assistant Surgeon -
Anesthesia - General
Blood Loss - Minimal
Complication - None
Findings - perforated duodenal ulcer
Specimens -
Procedure Performed-
repair of perforated duodenal ulcer
lavage of heavy abdominal contamination
placement of tunnel intraabdominal drain
Patient comes in with the above diagnosis and was consented for the above procedures. Risks, benefits, and alternatives were discussed with patient, which includes, but are not limited to, postoperative or chronic pain, bleeding, wound infection, hematoma, post-operative abscess, injury to other organs, or need for further procedures or workup. Other Complications may include deep vein thrombosis(blood clots), as well as other side effects affecting other organ systems such as the heart or lungs, and in rare circumstances, death as a result of the above complications. The patient was informed, and agree that sometimes, a feeding tube may have to be placed for post-operative drainage. The patient understands and agrees to proceed with the proposed procedure.
The patient was given preoperative antibiotics.
The patient was brought to the OR where the patient was placed supine on OR table
Time-out was performed and all was in agreement concerning the case.
Patient was prepped and draped in the usual fashion.
An upper midline incision was performed using 10. Scalpel. Dissection was carried down to the fascia. The fascia was opened carefully using a 10. Scalpel.
Once we entered abdominal cavity, there was a large amount of murky contaminated fluid. Suction irrigation was used to wash out remove the fluid.
Headlight was used for proper illumination.
Evaluation showed patient has a perforation of the duodenum.
The defect was closed primarily using interrupted suture
Next a tongue of omentum was mobilized. 3 additional sutures were used to perform a patch repair of the defect.
This was done by placing the omentum over the defect.
Three sutures were then used to pin down the patch to the defect.
Once repair was completed, additional irrigation was used to washout the abdominal cavity.
We irrigated until the fluid is clear.
Hemostasis was completely obtained. No organ injury was seen.
One JP drain was tunneled and positioned intra-abdominally under direct vision.
The NG tube was palpated and, with the help of anesthesia, properly directed into position in the body stomach.
At the end of the case, counts were carried out. When instrument, sponge, and needle
counts were completed and reported to me as correct, then I began the closure.
The fascia was closed using PDS or Prolene sutures.
The skin was staple.
The patient tolerated the procedure well and was transferred to the recovery room in stable and satisfactory condition.