A Comparative Study between the Outcome of Primary Repair versus Loop Ileostomy in Ileal Perforation.

Sushil Mittal,Jyoti Sharma,Harnam Singh,Anand Munghate,Gurpreet Singh,Anjna Garg

doi:10.1155/2014/729018

Abstract

Introduction. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. Randomisation was done by senior surgeons by picking up card from both the groups. The surgical management was done as primary repair (group A) and loop ileostomy (group B). Results. An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. A ratio of 1 : 1.51 days was observed between hospital stay of group A to group B. Conclusion. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. It should be recommended that ileostomy in these cases is only temporary and the extra cost and cost of management are not more than the price of life.

Highlights

Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries
The aim of the present study is to evaluate the outcome of primary repair versus loop ileostomy in cases of ileal perforation by comparing them in terms of postoperative morbidity, mortality and cost-effectiveness, and complications and to find out the ideal procedure
The surgical management was done as primary repair and loop ileostomy; comparative study was done between both procedures

Summary

Introduction

Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. The surgical management was done as primary repair (group A) and loop ileostomy (group B). An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. Despite the availability of modern diagnostic facilities and advances in treatment regimes, this disease has an abrupt onset and a rapid downhill course with a high mortality if not treated [2, 3]

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Discussion

Conclusion