The benefits of protective defunctioning ileostomy in ileal perforation surgery
DOI:
https://doi.org/10.18203/2349-2902.isj20192994Keywords:
Defunctioning ileostomy, Faecal fistula, Ileal perforation, Protective ileostomyAbstract
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.
References
Mittal S, Singh H, Munghate A, Singh G, Garg A, Sharma J. A comparative study between the outcome of primary repair versus loop ileostomy in ileal perforation. Surg Res Prac. 2014;2014:729018.
Siddiqui FG, Shaikh JM, Soomro AG, Bux K, Memon AS, Ali SA. Outcome of Ileostomy in the Management of Ileal Perforation. JLUMHS. 2008;7(3):168-72.
Verma H, Pandey S, Sheoran KD, Marwah S. Surgical audit of patients with ileal perforations requiring ileostomy in a Tertiary Care Hospital in India. Surg Res Prac. 2015;351548:4.
Wani RA, Parray FQ, Bhat NA, Wani MA, Bhat TH, Farzana F. Nontraumatic terminal ileal perforation. World J Emerg Surg. 2006;1(1):7.
Karmakar SR, Bhalerao RA. Perforations of terminal ileum. Indian J Surg. 1972;34:422-6.
Gordon PH, Rolstad BS, Bubrick MP. Intestinal stomas. In: Principles and practice of surgery for the colon, Rectum and Anus. Gordon PH, Nivatvongs S. eds. St Louis; Quarterly Med. 1999: 1117-80.
Chowdhury JU, Iftekhar MH, Shaheed N. Development of an ideal operative procedure in typhoid perforation management. ORION. The ORION Med J. 2010;33(1):716-17.
Ansari AG, Naqvi SQ, Ghumro AA, Jamali AH, Talpur AA. Management of typhoid ileal perforation: a surgical experience of 44 cases. Gomal J Med Sci. 2009;7:27-30.
Dunn KMB, Rothenberger DA. Colon rectum and anus. 9th ed. In Schwartz Principles of Surgery, Charles F Bruni cardi. Ed. New York: McGraw Hill Publication. 2010:103.
Kim JP, Oh SK, Jarrett FR. Management of ileal perforation due to typhoid fever. Ann Surg. 1975;181(1):88.
Vaidyanathan S. Surgical management of typhoid ileal perforation. Ind J Surg. 1986:335-41.
Roy CC, Doma BT, Bodhisattva B. A study of complications of temporary ileostomy in cases of acute abdomen with ileal perforation and obstruction. Int Surg J. 2018;5(10):3265-72.
Ramanaiah J, Kumar CP, Indla R. Protective Ileostomy in Ileal Perforation and Its Outcome Compared to Primary Repair. J Med Sci Clinic Res. 2019;7(3):1341-5.
Sher-uz-Zaman M, Hameed F, Atiq-ur-Rehman S, Khan Y. Loop ileostomy: complications in cases of enteric perforation. Prof Med J. 2011;18(2):222-7.
Howard RS, Simmons RL. Tuberculosis of large bowel. Chapter 1. In: Surgical infectious disease 3rd ed. Appleton and Lange. 1996: 145-148.
Khoo RE, Cohen MM, Chapman GM, Jenken DA, Langevin JM. Loop ileostomy for temporary fecal diversion. The Am J surg. 1994;167(5):519-22.
Malik AM, Laghari AA, Mallah Q, Qureshi GA, Talpur AH, Effendi S, et al. Different surgical options and ileostomy in typhoid perforation. World J Med Sci. 2006;1(2):112-6.
