Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin

BMC Gastroenterology

Research Article

Roberto Caronna¹  Thierry Hessou²  Cesar Ahononga²  Sosten Adeniran²  Dieudonnè Zaongo²  Rènè Castro Gayito²  Giambattista Priuli²  Alassan Kadiri Boukari² 

[1] Department of Surgical Sciences, Sapienza University of Rome, Policlinico Umberto I Viale del Policlinico 155, 00161, Rome, Italy;Hôpital Saint Jean de Dieu, B.P. 7, Tanguièta, Benin;

关键词: Typhoid Fever;    Primary Repair;    Intestinal Resection;    Anastomotic Dehiscence;    Perforation Site;   

DOI  :  10.1186/1471-230X-13-102

 received in 2012-11-23, accepted in 2013-06-10,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.Methods111 patients with acute peritonitis underwent emergency laparotomy: number of perforations, distance of perforations from the ileocaecal valve, and type of surgery performed were recorded. A laparostomy was then created and explored every 48 to 72 hours. The patients were then divided into two groups according to the surgical technique adopted at the initial laparotomy: primary repair (Group A) or intestinal resection with anastomosis (Group B). Clinical data, intraoperative findings, complications and mortality were evaluated and compared for each group.ResultsIn 104/111 patients we found intestinal perforations, multiple in 47.1% of patients. 75 had primary repair (Group A) and 26 had intestinal resection with anastomosis (Group B). Group B patients had more perforations than patients in Group A (p = 0.0001). At laparostomy revision, the incidence of anastomotic dehiscence was greater than that of primary repair dehiscence (p = 0.032). The incidence of new perforations was greater in Group B than in Group A (p = 0.01). Group B correlates with a higher morbility and with a higher number of laparostomy revisions than Group A (p = 0.005).There was no statistical difference in terms of mortality between Group A and Group B. Presence of pus in the abdominal cavity at initial laparotomy correlates with significantly higher mortality (p = 0.0001).ConclusionsResection and anastomosis shows greater morbidity than primary repair. Laparostomy revision makes it possible to rapidly identify new perforations and anastomotic or primary repair dehiscences; although this approach may seem aggressive, the number of operations was greater in patients who had a favourable outcome, and does not correlate with mortality.

【 授权许可】

CC BY   
© Caronna et al.; licensee BioMed Central Ltd. 2013