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ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 170-175

Determinants of outcome in gastrointestinal perforations with special reference to clavien–dindo classification of surgical complications: Experience of a Single Institute in Central Rajasthan


Department of General Surgery, J.L.N Medical College, Ajmer, Rajasthan, India

Correspondence Address:
Amit Singh
Department of General Surgery, J.L.N Medical College, Ajmer, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.202365

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Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies across the world. In developing countries, gastrointestinal perforations have very high morbidity and mortality rates, irrespective of the type of operative procedure performed. The aim of the present study was to evaluate and find out various determinants for safe outcome in gastrointestinal perforation in terms of decreased morbidity and mortality and applying Clavien–Dindo classification for postoperative complications for evaluating the outcome. Patients and Methods: A nonrandomized retrospective study with collected data from 350 patients with gastrointestinal perforations was conducted over a period of 3 years. Data from various preoperative and operative factors, surgical technique, and complications were recorded. The output was measured as better and worse, as per the classification proposed by Clavien–Dindo. Results: The study enrolled 350 patients with a male:female ratio of 3.3:1; 58% of the patients were <40 years of age. The most common etiologies of perforation peritonitis were peptic perforation (duodenal 42%, gastric 8%), small bowel perforation (jejunum 3.14%, ileal 26.28%), appendicular perforation (10%), and cecum and colon constituting 4.85% each. The incidence of major complications was wound infections 18%, respiratory complications 16.57%, burst abdomen 5.14%, leak 4%, and septicemia 7.14%. Overall mortality was 10.85%. High mortality was observed in ileal perforation. Conclusion: Preoperative comorbidities, operative techniques, and postoperative complications in this setting are associated with morbidity and mortality. Proper screening on admission should be done to identify premorbid illness, and with the use of some recommendations in surgical technique we can achieve safe outcome of gastrointestinal perforations. The Clavien–Dindo classification can be adapted to assess the severity of postoperative complications following gastrointestinal perforations.


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