A clinical comparative retrospective cohort study in the surgical management of enteric perforation, by comparing primary closure and closure with free omental sheet graft

Anantha Raju G. S.


Background: Typhoid ileal perforations have high morbidity and mortality rates irrespective of the type of surgeries performed. The aim of this study is to evaluate the morbidity, mortality and cost-effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison with a primary ileal perforation closure.

Methods: This study includes a total of 81 patients with enteric perforations in a span of 5 years from March 2009 to February 2014. The study was divided into two groups; group 1 included 40 cases in which primary enteric perforation closure was done and group 2 included 41 cases in which a free omental sheet graft was used in typhoid enteritis with perforation. The outcomes were measured in relation to various postoperative complications and mortality.

Results: 90% of the patients in Group 1 had surgical site infection and 65% of the patients in Group 2 had surgical site infection. Intra-abdominal abscess was seen in 5% of the patients in Group 1, whereas no such morbidity was found in Group 2. 25% of the Group 1 patients had fecal fistula compared to none in Group 2. The mortality rate in Group 1 was 10% and no mortalities were seen in Group 2.

Conclusions: Primary closure with free omental sheet graft has shown better results, compared to primary closure alone, in terms of morbidity, mortality and length of hospital stay, irrespective of the site of perforation.


Enteric perforation, Fecal fistula, Free omental sheet graft

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