Yuda Handaya Adeodatus, Andrew Joshua, Hanif Ahmad Shafa, Tjendra Kevin Radinal, Kresna Aditya Azriel Farrel
Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Ann Med Surg (Lond). 2021 Jul 30;68:102647. doi: 10.1016/j.amsu.2021.102647. eCollection 2021 Aug.
Gastric perforation is a life-threatening condition. Patients with gastric perforation with Boey score 3 has very high mortality rate. Immediate source control is required for primary repair and preventing further complications. Furthermore, elderly patients pose a greater risk of morbidity and mortality in cases of gastric perforation, especially during and after emergency surgery.
We present two cases of elderly patients with gastric perforation with Boey score 3. We performed omental plugging technique with double horizontal mattress suture type. In these cases, we decided not to perform biopsy and margin freshening of the perforation.
We performed omental plugging technique because we are confident that it could cover the perforation completely without causing gastric outlet obstruction. An emergency source control surgery can be effectively done with this omental plugging procedure. During surgery, margin freshening and biopsy is not performed to perform source control more quickly. This surgical procedure aligned with "quick in-quick out" concept that we adopted for treating patients with gastric perforation. Omental plugging also allows patient to undergo ERAS program for better and faster recovery. The patients were discharged from the hospital without further complications and long-term follow-up showed good results.
Omental plugging has the least risk of complications than other perforation repair techniques and can be done for small and large perforation. Based on our case series, omental plug with double mattress suture is an effective and safe procedure to be performed in elderly patients with gastric perforation with Boey score 3.
胃穿孔是一种危及生命的疾病。Boey评分为3分的胃穿孔患者死亡率非常高。进行一期修复和预防进一步并发症需要立即控制源头。此外，老年患者在胃穿孔病例中，尤其是在急诊手术期间和术后，发病和死亡风险更大。
我们报告了两例Boey评分为3分的老年胃穿孔患者。我们采用双水平褥式缝合类型的网膜填塞技术。在这些病例中，我们决定不进行穿孔部位的活检和创缘修整。
我们采用网膜填塞技术是因为我们确信它能完全覆盖穿孔而不会导致胃出口梗阻。通过这种网膜填塞 procedure可以有效地完成紧急源头控制手术。在手术过程中，不进行创缘修整和活检以更快地进行源头控制。这种手术 procedure与我们治疗胃穿孔患者所采用的“快速进-快速出”概念相一致。网膜填塞还允许患者接受加速康复外科（ERAS）计划以实现更好、更快的康复。患者出院时没有进一步的并发症，长期随访显示效果良好。
与其他穿孔修复技术相比，网膜填塞并发症风险最小，大小穿孔均可采用。基于我们的病例系列，双褥式缝合的网膜填塞对于Boey评分为3分的老年胃穿孔患者是一种有效且安全的手术。
