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Comparative Study
. 2013 Jun 19:13:102.
doi: 10.1186/1471-230X-13-102.

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

Roberto Caronna, Alassan Kadiri Boukari, Dieudonnè Zaongo, Thierry Hessou, Rènè Castro Gayito, Cesar Ahononga, Sosten Adeniran, Giambattista Priuli
Comparative Study

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

Roberto Caronna et al. BMC Gastroenterol. .

Abstract

Background: The 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.

Methods: 111 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.

Results: In 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).

Conclusions: Resection 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.

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Figures

Figure 1
Figure 1
Primary repair technique.
Figure 2
Figure 2
Laparostomy and abdominal drains.
Figure 3
Figure 3
Multiple typhoid ileal perforations.
Figure 4
Figure 4
Site of perforations and surgical technique adopted. Group A: primary repair; Group B: intestinal resection with anastomosis; Other: other procedures.
Figure 5
Figure 5
Number of perforations (average) in Group A and Group B at initial surgery.
Figure 6
Figure 6
Complications observed at laparostomy revisions.
See this image and copyright information in PMC

References

    1. Crum NF. Current trends in typhoid fever. Current Gastroenterol Rep. 2003;5(4):279–86. doi: 10.1007/s11894-003-0064-0. - DOI - PubMed
    1. Ukwenya AY, Ahmed A, Garba ES. Progress in management of typhoid perforation. Ann Afr Med. 2011;10:259–65. doi: 10.4103/1596-3519.87040. - DOI - PubMed
    1. Hosoglu S, Aldemir M, Akalin S, Geyik MF, Tacyildiz IH, Loeb M. Risk factors for enteric perforation in patients with typhoid fever. Am J Epidemiol. 2004;160:46–50. doi: 10.1093/aje/kwh172. - DOI - PubMed
    1. Bhutta ZA. Current concepts in the diagnosis and management of typhoid fever. Br Med J. 2006;333:78–82. doi: 10.1136/bmj.333.7558.78. - DOI - PMC - PubMed
    1. Asefa Z. Pattern of acute abdomen in Yirgalem Hospital, southern Ethiopia. Ethiop Med J. 2000;38:227–235. - PubMed

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