Which more safe in small intestine emergency surgery? İleostomy, anastomosis and primary repair. İnce barsak acil cerrahisinde hangisi daha güvenli? İleostomi, anastomoz ve primer onarım

Introduction: Small intestine perforations are one of the major surgical problems in the worldwide for both patients and surgeons. Different surgical procedures can be applied in the choice of treatment and there is no definite option yet. Materials and methods: The cases who operated due to emergency small intestine pathology were included in the study. The cases were grouped according to the type of surgery: small intestinal anastomosis (Group I), ileostomy opened (Group II) and primary repair (Group III). Results: A total of 107 cases were included in the study. The mortality rates between the groups were 23% in Group I, 52% in Group II and 39% in Group III and there was a significant difference between them (p <0,05). There was no statistically significant difference between the leakage rates between the groups treated with primary repair and anastomosis (P: 0.6). Re-operation rates for different reasons were 17%, 23% and 17% for Groups I, II and III respectively and there was no significant difference between them (P: 0,804). The presence of organ failure, older age and ASA were significant (P <0.05) when the factors related to mortality were examined independently of the groups. Conclusion: We have seen that mortality and morbidity rate in small intestine emergency surgery can be very high no matter which method is applied surgically. Although there was no risk of anastomosis in the Ileostomy group, re-operation and mortality due to complications were more frequent.   OZET Giris: Ince barsak perforasyonlari hem hastalar hemde cerrahlar icin dunya genelinde onemli cerrahi sorunlardan birisidir. Tedavi seciminde farkli cerrahi prosedurler uygulanabilmekte olup henuz kesinlesmis bir secenek yoktur. Gerec ve yontemler: Acil ince barsak patolojisine bagli ameliyat edilen olgular calismaya dahil edildi. Olgular yapilan cerrahi tipine gore ince barsak anastomozu yapilan (Grup I),  ileostomi acilan (Grup II) ve primer tamir yapilanlar (Grup III) olarak gruplandirildi. Bulgular: Toplam 107 olgu calismaya dahil edildi. Gruplar arasi mortalite oranlari Grup I’de %23, Grupta II’de %52 ve Grup III’te %39 idi ve aralarinda anlamli farklilik saptandi(p<0,05). Primer tamir ve anastomoz uygulanan gruplar arasinda kacak oranlari arasinda anlamli fark yoktu (p: 0,6). Farkli nedenler ile re-operasyon oranlari Grup I, II ve III’te sirasiyla %17, %23 ve %17 idi ve aralarinda anlamli farklilik saptanmadi (p: 0,804). Gruplardan bagimsiz olarak mortalite ile iliskili faktorlere bakildiginda organ yetmezligi varligi, ileri yas ve ASA anlamli idi (p<0,05). Sonuc: Ince barsak acil cerrahisinin hangi yontem uygulanirsa uygulansin mortalitenin ve morbiditesinin oldukca yuksek olabilecegini gorduk. Ileostomi grubunda her ne kadar anastomoz kacagi riski olmasa da komplikasyonlarina bagli re-operasyon ve mortalite daha fazla goruldu.