POSTOPERATIVE OUTCOMES IN CHILDREN WITH TYPHOID ILEAL PERFORATION: PRIMARY REPAIR VERSUS ILEOSTOMY

Abstract

Objective

To evaluate and contrast the postoperative outcomes of primary repair versus ileostomy in pediatric patients with typhoid perforation.

Methodology

This comparative study, conducted in pediatric surgery unit, DHQ Teaching Hospital Timergara Lower Dir KPK, Pakisan.in the duration from December 2022 to May 2024, included 70 patients aged 3 to 18 years diagnosed with typhoid perforation. After ethical approval and informed consent from guardians, patients were randomly divided into two groups: Group A (35 patients) underwent primary repair, while Group B (35 patients) received an ileostomy. Preoperative administration of broad-spectrum antibiotics was standard for all patients. Postoperative outcomes, including complications and mortality rates, were documented and analyzed using SPSS version 20.0, with categorical variables compared via the chi-square test to identify the more effective surgical intervention.

Results

This study compared outcomes of primary repair (Group A) versus ileostomy (Group B) in 70 pediatric patients with typhoid ileal perforation. Group A had a mean age of 10.5 years and Group B, 11.8 years, with a slightly higher proportion of males in both groups. Most patients had unsatisfactory socio-economic conditions and rural residency. Symptoms included abdominal pain (91%), pyrexia (87%), abdominal distention (81%), constipation (59%), vomiting (53%), and diarrhea (21%). Local complications were significantly higher in the ileostomy group, with notable differences in wound dehiscence, infection, and skin excoriation. Systemic complications like electrolyte disturbance and weight loss were also more frequent in the ileostomy group. Mortality was higher in the ileostomy group but not statistically significant. Primary repair demonstrated fewer complications and better outcomes, indicating it as the more effective treatment for pediatric typhoid perforation.

Conclusion

Our study favors primary repair over ileostomy for typhoid ileal perforation, showing fewer postoperative complications like wound issues and electrolyte disturbances. While both procedures had similar mortality rates, primary repair appears safer and more effective, especially for patients without significant health complications. This draw attention to the importance of choosing primary repair when managing this condition to improve surgical outcomes and patient recovery.