Pawan Agarwal

Repair of Duodenal Fistula with Rectus Abdominis Musculo-peritoneal (Ramp) Flap Pawan Agarwal

Defects in the duodenal wall caused by trauma, giant perforation and duodenal fistula are technically difficult to repair and associated with high morbidity and mortality. Usually the defect can be closed primarily but in above mentioned conditions large defects are difficult to repair. Majority of duodenal perforations are closed best by omental patch. At such times, one has to use other techniques of managing the problem. In such cases various technically demanding operations have been proposed. Apart from more challenging surgical procedures, the pedicled flap of rectus abdominis muscle along with peritoneum (RAMP) for repair of duodenal defect may be an alternative in the treatment of high-risk patients. This flap is easy to construct and can cover large defect in the duodenal wall without any serious complications. Flap contains adequate blood supply, which help in healing of duodenal wall defect with excellent results. With these considerations in mind we investigated the results of RAMP flap for repair of large duodenal wall defect. This book is useful for trainee as well as practicing surgeons.