title: Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin.
abstract: BACKGROUND
  The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.
  
  
  METHODS
  111 patients with acute peritonitis underwent emergency laparotomy: number of perforations, distance of perforations from the ileocaecal valve, and type of surgery performed were recorded. A laparostomy was then created and explored every 48 to 72 hours. The patients were then divided into two groups according to the surgical technique adopted at the initial laparotomy: primary repair (Group A) or intestinal resection with anastomosis (Group B). Clinical data, intraoperative findings, complications and mortality were evaluated and compared for each group.
  
  
  RESULTS
  In 104/111 patients we found intestinal perforations, multiple in 47.1% of patients. 75 had primary repair (Group A) and 26 had intestinal resection with anastomosis (Group B). Group B patients had more perforations than patients in Group A (p = 0.0001). At laparostomy revision, the incidence of anastomotic dehiscence was greater than that of primary repair dehiscence (p = 0.032). The incidence of new perforations was greater in Group B than in Group A (p = 0.01). Group B correlates with a higher morbility and with a higher number of laparostomy revisions than Group A (p = 0.005).
  
  
  CONCLUSIONS
  Resection and anastomosis shows greater morbidity than primary repair. Laparostomy revision makes it possible to rapidly identify new perforations and anastomotic or primary repair dehiscences; although this approach may seem aggressive, the number of operations was greater in patients who had a favourable outcome, and does not correlate with mortality.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caronna
authors.forename: Alassan Kadiri
authors.initials: AK
authors.lastname: Boukari
authors.forename: Dieudonnè
authors.initials: D
authors.lastname: Zaongo
authors.forename: Thierry
authors.initials: T
authors.lastname: Hessou
authors.forename: Rènè Castro
authors.initials: RC
authors.lastname: Gayito
authors.forename: Cesar
authors.initials: C
authors.lastname: Ahononga
authors.forename: Sosten
authors.initials: S
authors.lastname: Adeniran
authors.forename: Giambattista
authors.initials: G
authors.lastname: Priuli
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001541:Benin; D002648:Child; D002675:Child, Preschool; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007082:Ileum / Q000601:surgery*; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012772:Shock, Septic / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000150:complications*; D055815:Young Adult