What is the technique called when the omentum (omentum) is used to cover the site of perforation in a perforated intestine, possibly starting with G?

Graham Patch Technique for Intestinal Perforation Repair

The Graham patch technique is the surgical procedure where the omentum is used to cover a site of intestinal perforation, particularly in perforated peptic ulcers. 1 This technique involves suturing the perforation and then placing a piece of omentum over the repair to reinforce it.

Technique Details

The Graham patch technique consists of:

• Primary closure of the perforation with sutures
• Placement of viable omental tissue over the suture line
• Securing the omental patch in place with additional sutures

For laparoscopic repairs, a simplified "one-stitch" technique may be used where:

• A single suture is placed through the perforation without knotting
• The suture is then tied over the omental patch 2

Indications and Effectiveness

Small vs. Large Perforations

• For small perforations (<2 cm):

  • Simple closure with or without an omental patch is effective 3
  • Evidence suggests that simple closure alone may be equally effective as adding an omental patch for small perforations 1
  • The addition of an omental patch does not clearly improve outcomes for perforations <2 cm 3

• For large perforations (≥2 cm):

  • A tailored approach based on location is recommended
  • For large gastric ulcers, resection should be considered, especially if malignancy is suspected
  • For large duodenal ulcers, resection or repair with/without pyloric exclusion may be needed 1
  • In extremely large defects (>2.5 cm), a free omental plug in the form of a mushroom may be used 4

Clinical Considerations

• The Graham patch technique increases operative time and requires more advanced laparoscopic skills compared to simple closure 1
• It may be particularly beneficial for ulcers with friable edges to reduce the risk of sutures cutting through tissue 3
• The leakage rate with proper repair is approximately 1-2% of cases 1
• Postoperative complications to monitor include leakage and wound infection 1

Variations of the Technique

• Standard Graham patch: Omental patch sutured over the primary closure
• Free omental plug: Used for giant perforations (>2.5 cm) where the omentum is shaped into a mushroom-like plug 4
• One-stitch technique: A simplified laparoscopic approach with a single suture tied over the omental patch 2

Outcomes

• The technique has been shown to reduce the incidence of fecal fistula formation compared to primary closure alone (1.1% vs 7.7%) 5
• Lower mortality rates have been reported with omental patch repair compared to primary closure alone (1.1% vs 3.3%) 5
• Laparoscopic omental patch repair has demonstrated advantages including decreased postoperative pain and faster recovery 6

The Graham patch technique remains a valuable and dependable method for repairing intestinal perforations, particularly when dealing with friable tissue or larger defects where simple closure alone might be inadequate.