Comparative study of operative procedures in typhoid perforation

The present study was conducted in 200 patients of typhoid perforation treated surgically. The aim of the study was to compare the results of different operative procedures done in enteric perforation in terms of morbidity, mortality, and cost effectiveness and to find out the ideal operative procedure. Observations were compared using statistical methods such as Chi-Square test and standard error of difference between proportions. The overall morbidity and mortality were 51% and 10.5% respectively. The morbidity and mortality were not affected by the type of operative procedure and the duration of perforation at presentation (P value >.05). Common postoperative complications included wound infection (23%), bleeding (5.5%), fecal fistula (16.5%) and skin excoriation around ileostomy (5.7%). The number of perforations and the development of fecal fistula were factors which significantly affected mortality (P value <. 025 and <. 001 respectively). Primary temporary ileostomy and ileo-transverse colostomy were performed in some patients with multiple perforations andor with perforation situated near the ileo-cecal junction having greater risk of "repair leak". In conclusion, repair of the perforation is a better procedure than temporary ileostomy in enteric perforation due to its cost effectiveness and absence of complications related to ileostomy. Ileostomy and ileo-transverse bypass should be considered as treatment options in patients with an unhealthy gut.

Keywords
Typhoid perforations, repair of perforation, primary ileostomy, repair with ileo-transverse colostomy