LAPAROSTOMY: A LIFE SAVING OPTION IN PATIENTS WITH DELAYED PRESENTATION OF PERFORATED SMALL BOWEL IN THE EMERGENCY DEPARTMENT
Abstract
Objective: To evaluate the effectiveness of laparostomy as a life saving procedure in patients with late presentation for
small bowel perforations in emergency.
Material and Methods:This comparative trial was conducted in the department of surgery at Lady Reading Hospital
Peshawar Pakistan from January, 2014 till December 2016. Following ethical approval from the ethical committee of
Lady Reading Hospital Peshawar all patients presenting to the emergency department with evidence of gas under
diaphragm on chest X ray were admitted and resuscitated with intravenous fluids, analgesia and antibiotics. A detailed
history and examinations were performed following which they were sent to the Operating room for laparotomy. Patients
of all ages with evidence of severe peritonitis secondary to spontaneous perforation of the small bowel, perforated
appendicitis and perforated duodenum were included in the study. Patients with evidence of malignancy or colonic/
gastric perforations were excluded from the study.Group A included patients that were primarily closed using polypropylene
0 or 1 en masse; whereas group B included patient that had their abdominal wall left open with covering of the
wound with either a Bogota bag fashioned from a drainage bag or polyethylene sheet.
Results: During the period of three years 1123 laparotomies were performed out of which 561(49.95%) were performed
in emergency department. 50 patients were place in each group with male preponderance (p value =0.51 ). Age of
patients was between 16-58{mean age age equals to group A ( 31.3yrs vs, group B(33.8yrs)}.A significantly higher mortality
was observed in patients not subjected to laparotomy. 3(6%) vs. 11(22 %) ( p=0.778). Incisional hernia frequency
was more in cases with infection and majority of closure of ventral wall defects were either achieved on completion of
1 year following failure of sequential facial closure or primary closure. The incisional hernias were performed by CST
with or without re enforcement with poly propylene mesh. There was a significantly higher time spent by patients on
ventilatory support following laparotomy in patients from group A (p=0.041)
Conclusion: Performing a Laparostomy in time can significantly reduce mortality with patients treated for secondary
bacterial peritonitis. Fistulation is slightly greater in cases where the abdominal wall is closed primarily with re-laparotomy
on demand but this can be reduced by decreasing the duration of exposure and use of a Bogota bag to cover the
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