Graham in his series treated 51 cases with free omental patch without. After placing through and through sutures, they are tied in an attempt. Acute first part of duodenum (D1) perforation is simple closure of perforation in. Laparoscopic repair and sutured omentoplasty, followed by focused sequential lavage in a systematic manner, if performed diligently, will yield good outcomes. There were no leaks or reoperations in our series. Respiratory complications was the most common postoperative complication in our series (9 patients), whereas 2 patients had ileus. None of our patients had postoperative intra-abdominal complications, but unfortunately 1 patient succumbed to respiratory complications. It was then followed by peritoneal lavage in a focused sequential manner that involved quadrant to quadrant lavage with tilting of operating table and changing of position between the surgeon and the camera surgeon. The perforation was closed primarily and reinforced with omental patch. We propose a standardized technique of repair and lavage with the outcomes of 50 consecutive patients treated at our institution.
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