DOI: 10.36347/sjams.2015.v03i03.058

Pages: 1326-1331

Decision making regarding repair or stoma has been a controversial theme in emergency surgery. We therefore reviewed our institutional experience with regard to decision regarding surgery and morbidity. A prospective study was conducted on hundred patients taken up for emergency laparotomy for various indications, in JA group of hospitals, GRMC, Gwalior, from September 2013 -August 2014. Half the patients selected had undergone primary repair (PR) whereas the other half had stoma formation (SF). Patients were assessed for pertinent clinical information and individuals requiring either of the two surgeries were compared. Non- traumatic perforation constituted 61% of indication for PR and SF. An adverse set of preoperative and intraoperative parameters were found in patients who underwent SF compared to PR group. Wound infection was the most common complication (28%) in both the groups. Surgical outcome, with reference to complications, was 52% in PR group and 64% in SF. Overall mortality was 8%. Morbidity, in either groups, is significantly influenced by an advanced age, a low Hb, hypoalbuminemia, an advanced lag period (>72 hours) and poor hemodynamic stability at the time of operation. The mean duration of hospital stay following either PR or SF is 10±3 days. PR is a safe procedure in emergency surgeries as long as patient is stable preoperatively and peritoneal cavity is non- compromised. SF seems to be a better option in adverse patient conditions. Patient outcome is influenced by poor clinical parameters and patient demographic in either surgery.