✦ PEPTIC ULCER · EMERGENCY SURGERY

Laparoscopic Repair of Perforated Ulcer (Graham Patch Repair)

Q: Is definitive ulcer surgery done at the same time as perforation repair?

No — the immediate priority is sealing the perforation with a Graham patch and controlling peritonitis. H.pylori eradication after recovery is the definitive treatment.

Q: How quickly must a perforated ulcer be operated on?

Surgery should be performed within 6–12 hours of perforation. Every hour of delay increases the risk of widespread peritonitis and mortality.

Q: Can laparoscopic Graham patch repair be done in all patients?

Laparoscopic repair is performed in haemodynamically stable patients. Haemodynamically unstable patients may require open surgery.

Emergency keyhole closure of a perforated peptic ulcer with omental patch — same outcomes as open, faster recovery.

60–120 Min TREATMENT DURATION

3–5 Days CARE SETTING

Laparoscopic APPROACH

2–3 Weeks RECOVERY TIMELINE

What is Laparoscopic Repair of Perforated Ulcer (Graham Patch Repair)?

A perforated peptic ulcer is a life-threatening emergency — gastric or duodenal ulcer erosion through the bowel wall causes sudden severe abdominal pain and peritonitis. Laparoscopic Graham patch repair closes the perforation with an omental plug through 3 small keyhole incisions, with thorough peritoneal lavage. Dr. Tagore Mohan Grandhi performs emergency laparoscopic Graham patch repair. The procedure must be performed urgently — morbidity and mortality increase significantly with every hour of delay. H.pylori eradication is commenced post-operatively to prevent recurrence.

Suitable for all patients with a perforated peptic ulcer, confirmed by free gas on chest X-ray or CT scan, requiring emergency surgical repair.

How the Procedure Works

Emergency Resuscitation

IV fluids, broad-spectrum antibiotics, NGT, urinary catheter. Free gas confirmed on chest X-ray or CT. Patient transferred urgently to theatre.

Laparoscopic Access

Three keyhole incisions. Perforation identified on the anterior duodenal or gastric wall. Degree of peritoneal contamination assessed.

Graham Patch Repair

Tongue of omentum drawn over the perforation and secured with 3–4 absorbable sutures, sealing the defect completely.

Peritoneal Lavage

Thorough lavage with 3–5 litres warm saline removing all contamination from the peritoneal cavity.

H.pylori Eradication

Triple therapy commenced post-operatively. Endoscopy at 6–8 weeks to confirm ulcer healing and H.pylori eradication.

Outcomes

60–120 MinTREATMENT DURATION

3–5 DaysCARE SETTING

LaparoscopicAPPROACH

2–3 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→3 small keyhole incisions versus a large midline laparotomy — significantly less pain
→Equivalent perforation sealing with equivalent clinical outcomes to open surgery
→Thorough peritoneal lavage under laparoscopic magnification and direct vision
→Faster return to eating and discharge 1–2 days earlier than open surgery

Laparoscopic Graham patch repair matches open surgery in efficacy while offering dramatically less pain and faster recovery. The priority is speed — every hour of delay increases complication risk significantly.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Is definitive ulcer surgery done at the same time as perforation repair?+

How quickly must a perforated ulcer be operated on?+

Can laparoscopic Graham patch repair be done in all patients?+

Not sure which treatment is right for you?

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