Comparison between Primary Repair and Ileostomy in the Management of  Typhoid Intestinal Perforation

Objective: To compare the outcomes of primary repair with ileostomy in the management of typhoid intestinal perforation. Study Design: Quasi-Experimental Study. Place and Duration of Study: Surgical Departments of Combined Military Hospital, and Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Jun 2022. Methodology: A total of 400 patients presenting with typhoid ileal perforation were recruited. Patients of either gender, aged under 60 years with a positive blood culture for S. Typhi were included. Those with a history of abdominal surgery or ileal perforation due to any cause other than typhoid were excluded. The study population was categorized into two groups (A, and B) of 200 patients each. Group-A received primary repair, and Group-B received ileostomy. Complications were compared between both groups. A primary outcome (mortality) was also examined. Results: Mean age of patients noted was 22.47±14.8 years. In Group-A, 124(62%) patients, and in Group-B 118(59%) patients were males. Postoperative wound infection was the most frequent complication found, in 32(16%) patients in Group-A and 44(22%) patients in Group-B. No complications were found in 96(48%) patients in Group-A and 80(40%) patients in Group-B. The mortality rate was higher in Group-B 34(17%) in comparison to Group-A 22(11%). Conclusions: Primary repair is a safe technique, and it has less morbidity and mortality in comparison to ileostomy for treatment of typhoid intestinal perforation.