A COMPARATIVE STUDY BETWEEN THE OUTCOME OF PRIMARY REPAIR VERSUS LOOP ILEOSTOMY IN ILEAL PERFORATION

Background: Ileal perforation is a critical surgical emergency associated with high morbidity and mortality if treatment is delayed. Among the management strategies, primary repair and loop ileostomy are the most commonly practiced procedures, yet the choice between them remains debated. Each approach carries distinct risks and benefits, and outcomes may vary depending on patient selection, intraoperative findings, and healthcare resources. Establishing evidence-based guidance is essential to optimize treatment strategies and improve survival in affected patients. Objective: To compare the demographic, clinical, and postoperative outcomes of primary repair versus loop ileostomy in patients with typhoid-associated ileal perforation. Methods: This randomized controlled trial was conducted over six months in a tertiary care hospital and included 70 patients aged 13–60 years presenting with ileal perforation within 48 hours of symptom onset. Patients were randomized into two groups: Group A underwent primary repair (n = 35) and Group B underwent loop ileostomy (n = 35). Demographic data, clinical presentation, and postoperative complications were recorded. Patients were followed for one month. Statistical analysis was performed using SPSS version 26, with chi-square and independent t-tests applied. A p-value ≤ 0.05 was considered statistically significant. Results: Baseline characteristics such as mean age (31.8 ± 10.5 vs. 32.6 ± 11.2 years, p = 0.678), gender distribution (male: 68% vs. 66%, p = 0.831), and BMI (22.4 ± 2.7 vs. 22.9 ± 3.1 kg/m², p = 0.451) were comparable between the groups. Postoperative outcomes, however, differed significantly. Surgical site infection was higher in the loop ileostomy group (50%, n = 18) compared with the primary repair group (20%, n = 7; p = 0.001). Mean hospital stay was significantly prolonged in loop ileostomy patients (12.4 ± 3.3 days) versus primary repair (7.6 ± 2.1 days; p < 0.001). Electrolyte imbalance occurred in 36% (n = 13) of loop ileostomy patients compared to 8% (n = 3) of primary repair patients (p = 0.001). Mortality was slightly higher in the ileostomy group (6%, n = 2) compared with primary repair (2%, n = 1), though not statistically significant (p = 0.307). Conclusion: Primary repair demonstrated superior short-term outcomes compared with loop ileostomy in patients with typhoid-associated ileal perforation, showing lower complication rates, reduced hospital stay, and fewer electrolyte imbalances. Loop ileostomy should remain reserved for unstable patients or those with extensive contamination. Careful patient selection and adherence to standardized surgical protocols can improve prognosis in this life-threatening condition.