Traitement chirurgical des perforations non traumatiques uniques de l'intestin grêle : excision–suture ou résection–anastomose

Objective. – To evaluate morbidity and mortality following excision-suture and resection-anastomosis for single non traumatic perforations of small bowel (SNTPB).

Methods. – from July 2002 to June 2003, a simple blind randomized study comparing excision-suture with resection-anastomosis SNTPB.

Results. – Of the 125 patients included, 112 were operated by surgeons on training (89.6%). The perforation sat on the antimesenteric edge of the last ileal portion with an average diameter of 0.8 cm (extreme 0.1 and 4 cm). An excision-suture was performed 66 times (52%) including 5 times by an experienced surgeon. 56 patients had simple continuations (45.2%). Morbidity concerned 68 patients (54,8%). 06 patients died of general complications (4.8%). The technique did not influence the mortality. All dead patients were operated by surgeons on training, P = 0.25. The complications were significantly more frequent after resection-anastomosis (79.7%) than after excision-suture (32.3%). The difference was significant for the parietal abscesses (P = 0,01), the exteriorized fistulas (P = 0.04), the septic shocks (P = 0.05).

Conclusion. – Whereas mortality was not influenced by the technique, the postoperative course was more complicated after resection-anastomosis (performed in majority by less experienced surgeons). We recommend excision-suture to repair SNTPB.