Comparison of Surgical Outcomes in Perforation Peritonitis Managed by Primary Repair, Diversion, and Staged Laparotomy

Minitha Anithakumari Komala Kumar; Trishala Nahata; Anannya Shetty; Pisagar Harshvardhan Maheshbhai

doi:10.36948/ijfmr.2026.v08i01.67193

Comparison of Surgical Outcomes in Perforation Peritonitis Managed by Primary Repair, Diversion, and Staged Laparotomy

Author(s)	Dr. Minitha Anithakumari Komala Kumar, Dr. Trishala Nahata, Dr. Anannya Shetty, Dr. Pisagar Harshvardhan Maheshbhai
Country	India
Abstract	Background: Perforation peritonitis continues to be one of the most frequent and life-threatening surgical emergencies encountered worldwide, particularly in low- and middle-income countries. Despite advances in resuscitation, antimicrobial therapy, anesthesia, and intensive care, postoperative morbidity and mortality remain unacceptably high. The heterogeneity of disease etiology, delayed presentation, degree of peritoneal contamination, and patient physiological reserve contributes to variability in outcomes. Surgical management strategies for perforation peritonitis broadly include primary repair, diversion procedures, and staged laparotomy (damage-control surgery). However, there is no universally accepted consensus regarding the optimal operative approach, and decision-making is often individualized based on intraoperative findings and surgeon discretion. Comparative data evaluating these strategies within a single institutional cohort remain limited. Objectives: The primary objective of this study was to compare postoperative surgical outcomes among patients with perforation peritonitis managed by primary repair, diversion procedures, and staged laparotomy. Secondary objectives included assessment of postoperative complications, length of hospital stay, need for re-intervention, and mortality, as well as identification of clinical and operative factors predictive of adverse outcomes. Methods: A retrospective cross-sectional analysis was conducted at a tertiary care teaching hospital over a six-year period. Adult patients who underwent emergency laparotomy for perforation peritonitis were included. Patients were categorized into three groups based on the definitive surgical strategy employed: primary repair, diversion, or staged laparotomy. Demographic characteristics, comorbid conditions, duration of symptoms, clinical severity at presentation, intraoperative findings (site of perforation, extent of contamination), and postoperative course were recorded. Outcomes were analyzed using appropriate statistical methods, and multivariate logistic regression was performed to identify independent predictors of postoperative morbidity and mortality. Results: A total of 312 patients were analyzed. Primary repair was the most commonly performed procedure in patients presenting early with localized or moderate contamination, whereas diversion and staged laparotomy were predominantly employed in patients with delayed presentation, extensive peritoneal soiling, or physiological instability. The overall postoperative complication rate was significantly lower in the primary repair group compared to diversion and staged laparotomy groups. Patients undergoing staged laparotomy experienced the highest incidence of postoperative complications, including surgical site infection, intra-abdominal sepsis, prolonged ventilatory support, and multi-organ dysfunction. The median length of hospital stay progressively increased from primary repair to diversion and staged laparotomy. Mortality rates were lowest in the primary repair group and highest among patients managed with staged laparotomy. Multivariate analysis identified advanced age, septic shock at presentation, feculent peritoneal contamination, and staged laparotomy as independent predictors of mortality. Conclusion: This study demonstrates that primary repair, when performed in carefully selected patients with favorable clinical and intraoperative profiles, is associated with superior surgical outcomes, including reduced postoperative morbidity, shorter hospital stay, and lower mortality. Diversion procedures and staged laparotomy remain essential and often lifesaving strategies in patients with advanced disease and severe physiological compromise; however, these approaches are associated with significantly higher postoperative burden. Early diagnosis, prompt surgical intervention, meticulous intraoperative assessment, and individualized operative strategy selection are critical determinants of outcome in perforation peritonitis.
Keywords	Keywords: Perforation peritonitis; primary repair; diversion; staged laparotomy; emergency laparotomy; surgical outcomes; retrospective study.
Field	Medical / Pharmacy
Published In	Volume 8, Issue 1, January-February 2026
Published On	2026-01-21
DOI	https://doi.org/10.36948/ijfmr.2026.v08i01.67193

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Comparison of Surgical Outcomes in Perforation Peritonitis Managed by Primary Repair, Diversion, and Staged Laparotomy

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