Single-layer closure of typhoid enteric perforation: Our experience

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Gastroenterology

Background:

• Typhoid enteritis with enteric perforation and peritonitis is increasingly prevalent in certain regions.
• Surgical repair methods for typhoid enteritis vary, often associated with high mortality and morbidity.
• This condition poses a significant challenge in pediatric surgical care.

Purpose of the Study:

• To compare the effectiveness of single-layer versus double-layer intestinal closure in pediatric patients with typhoid enteric perforation and peritonitis.
• To evaluate the impact of different closure techniques on postoperative complications and outcomes.

Main Methods:

• A retrospective study of 902 pediatric patients undergoing laparotomy for typhoid enteric perforation between September 2007 and April 2012.
• Patients were divided into two groups: Group A (n=454) with double-layer closure and Group B (n=448) with single-layer closure.
• Clinical outcomes including burst abdomen, enterocutaneous fistula, and wound infection were recorded and compared.

Main Results:

• Single-layer closure (Group B) showed significantly lower rates of burst abdomen (0.6% vs 8.3%) and enterocutaneous fistula (1.7% vs 11.4%) compared to double-layer closure (Group A).
• Superficial wound infection rates were also substantially lower in the single-layer closure group (20.3% vs 47.3%).
• Mean length of hospital stay was shorter for patients with single-layer closure (29.4 days vs 45.3 days).

Conclusions:

• Single-layer intestinal closure is an effective surgical technique for managing typhoid enteric perforation in children.
• This approach leads to reduced complication rates and potentially shorter hospital stays.
• The findings suggest a superior method for surgical repair in pediatric typhoid enteritis.