title: Triple tube drainage for "difficult" gastroduodenal perforations: A prospective study.
abstract: OBJECTIVE
  To prospectively study the outcome of difficult gastroduodenal perforations (GDPs) treated by triple tube drainage (TTD) in order to standardize the procedure.
  
  
  METHODS
  Patients presenting to a single surgical unit of a tertiary hospital with difficult GDPs (large, unfavourable local and systemic factors) were treated with TTD (gastrostomy, duodenostomy and feeding jejunostomy). Postoperative parameters were observed like time to return of bowel sounds, time to start enteral feeds, time to start oral feeds, daily output of all drains, time to clamping/removal of all drains, time for skin to heal, complications, hospital stay, and, mortality. Descriptive statistics were used.
  
  
  RESULTS
  Between December 2013 and April 2015, 20 patients undergoing TTD for GDP were included, with mean age of 44.6 ± 19.8 years and male:female ratio of 17:3. Mean pre-operative APACHE II scores were 10.85 ± 3.55; most GDPs were prepyloric (9/20; 45%) or proximal duodenal (8/20; 40%) and mean size was 1.83 ± 0.59 cm (largest 2.5 cm). Median times of resumption of enteral feeding, removal of gastrostomy, removal of duodenostomy, removal of feeding jejunostomy and oral feeding were 4 d (4-5 IQR), 13 (12-16.5 IQR), 16 (16.25-22.25 IQR), 18 (16.5-24 IQR) and 12 d (10.75-18.5 IQR) respectively. Median hospital stay was 22 d (19-26 IQR) while mortality was 4/20 (20%).
  
  
  CONCLUSIONS
  TTD for difficult GDP is feasible, easy in the emergency, and patients recover in two-three weeks. It obviates the need for technically demanding and riskier procedures.
authors.affiliation: Nitin Agarwal, Department of Surgery and Renal Transplant, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Delhi 110075, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Nitin Agarwal, Department of Surgery and Renal Transplant, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Delhi 110075, India.
authors.forename: Nishant Kumar
authors.initials: NK
authors.lastname: Malviya
authors.affiliation: Nitin Agarwal, Department of Surgery and Renal Transplant, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Delhi 110075, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Nitin Agarwal, Department of Surgery and Renal Transplant, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Delhi 110075, India.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Singh
authors.affiliation: Nitin Agarwal, Department of Surgery and Renal Transplant, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Delhi 110075, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
keywords: APACHE; Duodenostomy; Peptic ulcer; Perforation peritonitis; Triple tube drainage