Background: Due to friable margins and the moribund state of the patient, managing giant duodenal perforations (>20 mm in diameter) is a challenging task.
Methods: A prospective randomized study of 100 patients with large-sized (> 20 mm) duodenal peptic perforation comparing omental plugging (study group) with omentopexy (control group) was carried out.
Results: Size of the perforation varied between 20 to 30 mm. No study group patients developed a postoperative perforation site leak, as compared with 6 patients in the control group. Gastric outlet obstruction was significantly less at 6 weeks and 5 years in the study group as compared with the control group, and mortality was significantly less in the study group.
Conclusion: It was concluded that omental plugging was a safe and reliable method of treatment for large-sized duodenal peptic perforations.