Single layer versus double layer closure of enteric perforation- a comparative study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20164526Keywords:
Acute abdomen, Faecal fistula, Peritonitis, Perforation repairAbstract
Background: Small intestine perforation and gastrointestinal haemorrhage are the most common and dreadful complications of enteric fever. There are different operative procedures available for enteric perforation repair. In the present study attempts should be made to find out which operative procedure (either single layer or double layer closure) should be planned in enteric perforation by comparing these, in terms of morbidity, mortality and cost effectiveness.
Methods: This study was carried out on 50 patients of either sex. They were divided in two groups Group- A (conventional double layer repair in 25 patients) and Group- B (single layer interrupted sutures in 25 patients). After analysing the result of this study, it can be concluded that single layer repair for enteric perforation can be constructed in less time and with less complication rate compared with the conventional two layer repair technique, it also recovers the patient early and causing earlier bowel activity than two layer repair.
Results: 50 patients were studied in the present study and results were in favour of single layer group as time taken for perforation repair and overall surgical time was less in this group. Moreover, single layer repair also helps early bowel activity and early recovery to the patient than double layer technique.
Conclusions: Double layer closure of enteric perforation offers no definitive advantage over single layer repair in terms of faecal fistula formation, operative time, returns of bowel movements and other complications like wound abscess formation, wound dehiscence, respiratory complications etc. Less operative time and other factors in favour of single layer repair makes it the choice of procedure for most of the surgeons.
References
Huckstep RL. Recent advances of typhoid fever. Ann R Coll Surg Engl. 1960;26:207-23.
Bhansali SK. GI perforation a clinical study of 96 cases. J Postgrad Med. 1967:13:1.
Prasad PB, Choudhary DK, Omprakash Typhoid perforation treated by closure and proximal side to side ileotransverse colostomy. J Ind Med Assoc. 1975;65:297.
Kaul BK. Operative management of typhoid perforation in children. Int Surg. 1975;60(8):407-10.
Purohit PG. Surgical treatment of typhoid perforations: Experience of 1976 Sangli epidemic. Indian J Surg. 1978;40:227–38.
Athie CG, Guizar CB, alcantra AV, Alcaraz GH, Montalvo EJ. Twenty five years of experience in the surgical treatment of perforation of the ileum caused by salmonella typhi at the general hospital of Mexico City. Surgery. 1998;123:632-6.
Olurin EO, Ajavi OO, Bohrer SP. Typhoid perforations. J Roy Coll Surg Edinb. 1972;17:353-63.
Eggleston FC, Santoshi B, Singh CM. Typhoid perforation of the bowel. Experiences in 78 cases. Ann Surg. 1979;190(1):31-5.
Ajao OG. Typhoid perforation: factors affecting mortality and morbidity. Int Surg. 1982;67(4):317-9.
Nadkarni KM, Shetty SD, Kagzi RS, Pinto AC, Bhalerao RA. Small-bowel perforations. A study of 32 cases. Arch Surg. 1981;116(1):53-7.
Rathore AH, Khan IA, Saghir W. Prognostic indices of typhoid perforation. Ann Trop Med Parasi. 1987;81(3):283-9.
Kim JP, Oh SK, Jarrett F. Management of ileal perforation due to typhoid fever. Ann Surg. 1975;181(1):88-91.
Kuruvilla MJ. Role of resection in typhoid perforation. Ann R Coll Surg Engl. 1978;60(5):408-11.
Shah AA, Wani KA, Wazir BS. The ideal treatment of the typhoid enteric perforation - resection anastomosis. Int Surg. 1999;84:35-8.
Ameh EA. Typhoid ileal perforation in children: a scourge in developing countries. Ann Trop Paediatr. 1999;19:267-72.
Shukla VK, Sahoo SP, Chauhan VS, Pandey M, Gautam A. Enteric perforation--single-layer closure. Dig Dis Sci. 2004;49:161-4.
