Efficacy of Primary Repair Versus Ileostomy Formation in Typhoid Perforation

Abstract

Background: Typhoid intestinal perforation (TIP) is a serious complication of emergency abdominal surgery in low-resource countries like Balochistan, Pakistan. In spite of improved antibiotics and perioperative care, the morbidity and mortality rates are still high. The issue of primary repair or loop ileostomy, especially when patients present late with generalized peritonitis and gross contamination remains a contentious one.

Objective: To compare the outcomes of postoperative primary repair and loop ileostomy in patients with typhoid intestinal perforation, in terms of complications, hospital stay, recovery time, and the prognosis in general.

Methods: The study is a prospective comparative observational study that will be carried out in Surgical Unit III, Department of General surgery, Civil Hospital Quetta, between February and July 2025. Sixty patients who had laparotomically confirmed typhoid ileal perforation were included. Surgical decision-making Surgical intervention was decided intraoperatively depending on the level of contamination, number of perforations and patient condition either primary repair or loop ileostomy. They were patients whose gender was divided equally (n=30 each). The SPSS v 26 was used to analyze the data. Continuous variables were represented in mean and SD and categorical variables represented frequencies and percentages. The use of independent t-test and chi-square test was done with p < 0.05 as significant.

Results: Primary repair demonstrated much better overall results than loop ileostomy (86.7% vs 60.0, p = 0.02) with fewer complications, shorter hospitalization and quicker recovery.

Conclusion: Primary repair is safe and effective in a limited number of patients especially those who present at the early stage, have little contamination and one perforation. Loop ileostomy is an option in severe cases but is related to increased morbidity and delayed recovery. Intraoperative evaluation should be done carefully in order to make the best surgical decision.