The benefits of protective defunctioning ileostomy in ileal perforation surgery

Abstract

Background: Perforation of bowel, particularly ileal perforation, is a significant emergency surgical problem in developing and underdeveloped nations and usually associated with high morbidity and mortality. The study is focussed on evaluating the impact of protective ileostomy in ileal perforation and to compare its outcome in term of post operative complication, hospital stay, psychological impact and mortality with primary surgery without ileostomy and observe its effect on prognosis of patient as a whole. Aim of the study we compared two modalities of treatment, primary surgery without ileostomy v/s primary surgery with protective defunctioning ileostomy with respect to post operative complications, duration of hospital stay, morbidity, mortality and psychological impact. Methods: We studied 50 patients of ileal perforation (diagnosed per-operatively) admitted to tertiary level hospital and operated upon for laparotomy. Patients were divided in 2 groups: Group A = Protective defunctioning ileostomy along with primary surgery, and Group B = Primary surgery alone. Primary surgery includes primary closure of perforation or resection and end to end anastomosis.Results: The commonest cause of non-traumatic ileal perforation was typhoid (52%) followed by non specific, tuberculosis and diverticulitis. Different types of operative procedures were performed. In Group A, total no. of dreaded complications like faecal fistula was 1 while in Group B, 10 patients developed faecal fistula. Other complications like wound infection and wound dehiscence were 28% in Group A while 96% in Group B. Overall mortality rate was 24% with 12% mortality in group A and 36% in group B. Mean hospital stay in Group A patient was 12.640±5.75 days (1-23 days) and those of group B was 23.760±16.04 days (5 - 59 days). Conclusions: Construction of protective defunctioning ileostomy in case of distal ileal perforation repair or anastomosis greatly reduces the dreaded complication and mortality in comparison to perforation repair or anastomosis without protective ileostomy. Although it is associated with ileostomy related complications, but they are only temporary and obviously no more than the price of life saved.