| Autor: |
MUKHOPADHYAY, ARUNIMA, MITRA, RAJU, KUNDU, SOURAV, BHOJ, SUDHANSU SEKHAR, DEY, RAMPRASAD |
| Předmět: |
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| Zdroj: |
Journal of Clinical & Diagnostic Research; Nov2021, Vol. 15 Issue 11, p18-22, 5p |
| Abstrakt: |
Introduction: The surgical management of Acute Intestinal Obstruction (AIO) may require resection of non viable gut in presence of strangulated bowel. After gut resection, the surgeon has to choose between a primary anastomosis and a creation of stoma only without anastomosis, to attain an uneventful recovery. Aim: To evaluate and compare the early postoperative outcome of patients of AIO treated with either primary anastomosis or with stoma only, without anastomosis following intestinal resection and to identify the factors associated with postoperative morbidity and mortality in both groups of patients. Materials and Methods: A cross-sectional study was conducted from July 2018 to June 2019 in a teaching hospital with tertiary care facility, on first 100 adult patients of AIO treated surgically within the study period with either primary anastomosis or with stoma formation only following gut resection. Patients undergoing primary anastomosis were placed in Group A (N=48) while patients undergoing stoma formation only were placed in Group B (N=52). Preoperative and postoperative data were collected and final outcome within the first two weeks of postsurgery was noted. The primary outcome was postoperative recovery or death of the treated patients. The secondary outcome was determined using parameters like time taken to resume oral diet, time of discharge from hospital and presence of postoperative complications in both groups of patients. Chi-square test and Mann-Whitney U tests were applied using confidence interval of 95% and p-value <0.05 considered as statistically significant. Results: Mean age in Group A was 44.5 years and in Group B was 38 years. Number of deaths was more in the stoma group and it was statistically significant (p-value=0.029). Among the factors related to death in both the groups, preoperative and postoperative leucocytosis, preoperative and postoperative hypoalbuminemia, preoperative uraemia and hyperkalaemia were more severe in the stoma group and these were statistically significant. Intraoperative presence of feculent peritoneal fluid was significantly higher in the group treated with stoma formation. Diabetes mellitus as a co-morbidity was significantly higher in the stoma group (p-value <0.001). Patients with stoma tolerated oral diet earlier and were discharged home earlier which were statistically significant (p-value <0.001). Wound infection and dehiscence were comparable in both groups. None of the procedure related specific complications were statistically significant in either group. Conclusion: Both procedures have their own benefits and limitations. Irrespective of the surgical procedure, early postoperative outcome is actually governed by factors controlling perioperative sepsis and presence of medical co-morbidities like diabetes. Patients with stoma formation have a better early postoperative outcome. Therefore, stoma formation without anastomosis is comparatively superior to primary anastomosis in AIO. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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