Comparative Study on Cellan Jones Repair and Modified Graham Patch Repair (Omentoplasty) in the Surgical Management of Perforated Duodenal Ulcer

Introduction: Duodenal ulcer perforation, a complication of peptic ulcer disease, has been treated surgically for over a century. Out of the various repair methods, Cellan Jones repair and Modified Graham Patch repair remain the most preferred approaches for small sized perforations <1.5cm. This study compares the postoperative outcomes, including wound infection rates, leak rates and morbidity, between the two techniques in a cohort of patients.

Methods: This prospective, randomized controlled study was conducted on 52 patients presenting with duodenal perforation at Government Medical College and Hospital, Chandigarh, from December 2022 to April 2024. To achieve an unbiased comparison group and a balanced randomization, permuted block randomization with fixed block size was used. Follow-up was conducted for a minimum of 30 days post-surgery to assess wound infection, leak rates, and other complications.

Results: Both techniques had similar wound infection rates, with Cellan Jones at 38.5% and MGPR slightly higher at 57.7% with a p value of 0.16. MGPR required longer operative times compared to Cellan Jones at a mean of 81.35 min vs 66.35 min respectively with a p value of < 0.01. MGPR also showed higher rates of certain postoperative complications, though overall morbidity and mortality rates were comparable between the two techniques which was overall statistically insignificant. Also, MGPR had a 0% leak rate, indicating superior sealing compared to the 7.7% leak rate in Cellan Jones Repair, however it was statistically insignificant (p value 0.49).

Conclusion: While both Cellan Jones Repair and MGPR are effective techniques for managing duodenal ulcer perforations, MGPR offers a marginally better outcome in preventing leaks but at the cost of a longer surgery and a higher rate of specific complications.