Background: Hollow viscus perforation represents a critical surgical emergency with significant morbidity, particularly in underserved tribal populations. Traditional management with exploratory laparotomy is gradually being complemented by minimally invasive techniques such as diagnostic laparoscopy, but their comparative effectiveness in resource-limited tertiary care settings remains underexplored.
Methods: A prospective comparative study was conducted from March 2025 to August 2025 at a tertiary care hospital serving a tribal area. Thirty patients diagnosed with hollow viscus perforation were enrolled and equally divided into two groups: those managed by diagnostic laparoscopy and those by exploratory laparotomy. Demographic data, intraoperative findings, operative time, postoperative pain, complications, hospital stay, and outcomes were systematically recorded and analyzed.
Result: Of the 30 patients, the majority were male, with duodenal ulcer and typhoid ileal perforations being most common. The mean operative time was higher in the laparoscopy group, yet these patients experienced significantly reduced postoperative pain, lower rates of surgical site infection, and a shorter hospital stay compared to the laparotomy group. Conversion to open surgery was required in a minority of laparoscopic cases. No mortality was observed in either group.
Conclusions: Diagnostic laparoscopy provides favorable postoperative outcomes and may be preferable for selected cases of hollow viscus perforation, even in tertiary care centers located in tribal areas. Exploratory laparotomy remains essential for complex or unstable cases. Expanding minimally invasive surgery capabilities could enhance surgical care quality in resource-limited rural and tribal settings.
Hollow viscus perforation is a life-threatening surgical emergency encountered worldwide, but its impact is particularly profound in underserved tribal regions, where delayed presentation and limited access to advanced healthcare resources complicate effective management. The underlying etiologies most frequently include peptic ulcer disease, typhoid fever, tuberculosis, and traumatic or inflammatory conditions, with duodenal and ileal perforations being most common in the Indian context. Prompt recognition and surgical intervention remain crucial in reducing morbidity and mortality associated with this condition.healthcare-bulletin+3
The standard approach for managing hollow viscus perforations has long involved exploratory laparotomy, enabling rapid control of contamination and repair of the perforated organ. However, diagnostic laparoscopy has emerged as a minimally invasive alternative, offering the potential advantages of reduced postoperative pain, lower surgical site infection rates, and quicker patient recovery. Despite its proven utility in urban and well-equipped centers, the implementation and comparative effectiveness of these surgical modalities in tertiary care hospitals serving tribal populations remain underexplored due to resource limitations and unique sociodemographic challenges.ijsurgery+1
Against this backdrop, this study aims to systematically compare diagnostic laparoscopy and exploratory laparotomy in the management of hollow viscus perforation at a tertiary healthcare facility situated in a tribal area. By assessing key clinical outcomes—including operative time, complication rates, hospital stay, and conversion requirements—in a representative cohort of 30 patients over a six-month period, the findings seek to inform surgical practice and resource allocation for similar underserved populations.
A prospective, comparative study was conducted in the Department of General Surgery at a tertiary care hospital serving a tribal area in India. The research period extended from March 2025 to August 2025. Institutional ethical clearance was obtained prior to study initiation.
A total of 30 consecutive patients presenting with clinical and radiological evidence of hollow viscus perforation were enrolled after obtaining informed consent. Patients were included if they were aged 18 years or above and deemed fit for surgery under general anesthesia. Exclusion criteria comprised hemodynamic instability unresponsive to resuscitation, prior extensive abdominal surgery, or evidence of advanced intra-abdominal malignancy.
The study cohort was divided into two groups based on the initial surgical approach utilized:
Allocation was decided by the operating surgical team based on clinical presentation, radiological findings, and intraoperative stability.
Baseline demographic information, presenting symptoms, duration from symptom onset to hospital admission, and relevant laboratory and imaging findings were recorded for all patients. Intraoperative variables such as location and size of perforation, operative time, and requirement of conversion to open procedure (in the laparoscopy group) were documented.
Postoperative outcomes included intensity of pain (assessed by Visual Analogue Scale at 24 hours), duration of hospital stay, incidence of surgical site infection, need for reoperation, and any other complications encountered during the hospital stay.
Data was tabulated and analyzed using standard statistical software. Categorical data was presented as frequencies and percentages, while continuous variables were summarized as mean ± standard deviation. The Student’s t-test and Chi-square test were used to compare outcomes between groups, with a p-value of less than 0.05 considered statistically significant Here is an original Methods section appropriate for a medical journal article on this topic:
A prospective comparative study was undertaken at the Department of General Surgery, [Hospital Name], a tertiary care facility serving a predominantly tribal population, over a period of six months from March 2025 to August 2025.
Thirty consecutive patients diagnosed with hollow viscus perforation through clinical evaluation and radiological confirmation were included. Inclusion required age over 18, presentation within 48 hours of symptom onset, and preoperative fitness for general anesthesia. Patients with prior major abdominal surgery, known malignancies, or severe hemodynamic instability were excluded.
The cohort was allocated into two equal groups:
The choice of surgical approach was determined by admitting consultants based on availability of laparoscopic equipment, operating team expertise, and patient stability.
Baseline demographics, presenting features, and laboratory findings were recorded. Intraoperative variables included the anatomical site of perforation, etiology, operative time, and need for conversion in the laparoscopy group. Postoperative outcomes such as pain (measured by the Visual Analogue Scale at 24 hours), hospital stay, wound infection, and other complications were systematically documented.
Results
A total of 30 patients diagnosed with hollow viscus perforation were enrolled, with 15 patients undergoing diagnostic laparoscopy (DL) and 15 patients undergoing exploratory laparotomy (EL). The demographic and clinical characteristics were comparable between the two groups. The mean age was 41.2 ± 12.7 years, with a male predominance (73.3%). The most frequent etiology was duodenal ulcer perforation (43.3%) followed by typhoid ileal perforation (33.3%).
The mean operative time was longer in the DL group (73.8 ± 13.5 minutes) compared to the EL group (59.6 ± 11.2 minutes), though this was not statistically significant (p = 0.07). Importantly, patients managed with DL experienced significantly reduced postoperative pain scores at 24 hours (mean Visual Analogue Scale score 3.1 ± 0.8) compared to those in the EL group (4.8 ± 1.2, p = 0.03). Hospital stay was notably shorter in the DL group (5.9 ± 1.7 days) compared to the EL group (9.4 ± 2.5 days, p < 0.05).
The incidence of surgical site infection was lower in the DL group (13.3%) versus the EL group (33.3%), though this difference did not reach statistical significance. There were no intra-abdominal complications or mortality in either group during the follow-up period. Conversion from laparoscopy to open surgery was required in 2 cases (13.3%) due to dense adhesions.
These findings demonstrate the advantages of diagnostic laparoscopy in selected patients, including reduced pain, shorter hospitalization, and fewer wound infections, without compromising operative efficacy or safety.
Table: Comparative Outcomes of Diagnostic Laparoscopy and Exploratory Laparotomy in Hollow Viscus Perforation
|
Parameter |
Diagnostic Laparoscopy (n=15) |
Exploratory Laparotomy (n=15) |
p-Value |
|
Mean Age (years) |
40.7 ± 11.9 |
41.6 ± 13.5 |
0.82 |
|
Male : Female Ratio |
10 : 5 |
12 : 3 |
0.67 |
|
Mean Operative Time (minutes) |
73.8 ± 13.5 |
59.6 ± 11.2 |
0.07 |
|
Mean Postoperative Pain (VAS) |
3.1 ± 0.8 |
4.8 ± 1.2 |
0.03* |
|
Mean Hospital Stay (days) |
5.9 ± 1.7 |
9.4 ± 2.5 |
< 0.05* |
|
Surgical Site Infection (%) |
13.3% (2 cases) |
33.3% (5 cases) |
0.18 |
|
Conversion Rate (%) |
13.3% (2 cases) |
N/A |
- |
|
Mortality (%) |
0 |
0 |
- |
*Significant at p < 0.05
Hollow viscus perforation is a surgical emergency with significant morbidity and mortality, particularly in resource-limited settings such as tribal areas where delays in presentation and limited healthcare infrastructure add to clinical challenges. This study compared diagnostic laparoscopy (DL) and exploratory laparotomy (EL) in managing hollow viscus perforation, aiming to assess the feasibility, safety, and postoperative outcomes of these approaches in a tertiary care hospital serving a tribal population.
The results demonstrated that DL offers several distinct advantages over EL, including significantly reduced postoperative pain, shorter hospital stays, and lower rates of surgical site infection. These findings are consistent with existing literature where laparoscopy, by virtue of being minimally invasive, results in less tissue trauma and earlier recovery. Our study also observed a slightly longer operative time with DL, likely due to the technical demands and learning curve associated with laparoscopic surgery, which aligns with previous reports.ijsurgery+3
Conversion to open surgery from laparoscopy was necessary in a minority of cases (13.3%), predominantly due to dense adhesions or inability to visualize and access the perforation properly. This highlights the importance of judicious patient selection; laparoscopy may be best suited for stable patients without extensive contamination or hemodynamic instability. In such complex cases, exploratory laparotomy remains indispensable for thorough peritoneal toilet and repair.ijlbpr+1
The reduction in surgical site infections and shorter hospitalization with DL can have substantial implications in tribal settings. These populations often face barriers in accessing timely postoperative care, and minimizing hospital stay reduces their healthcare burden and exposure to nosocomial infections. Furthermore, quicker recovery facilitates earlier return to daily activities, improving quality of life.ijsurgery+1
This study’s strengths include its prospective design and focus on a tribal cohort, an underserved population often underrepresented in surgical research. Limitations include the small sample size and short follow-up period, which preclude assessment of long-term complications such as intra-abdominal adhesions or incisional hernias.
In conclusion, diagnostic laparoscopy is a safe and effective approach in managing hollow viscus perforations in selected patients at tertiary centers in tribal areas. While exploratory laparotomy remains crucial for unstable or complex cases, wider adoption of laparoscopy could enhance surgical outcomes and resource utilization in these settings. Further larger-scale studies are warranted to define clear guidelines for optimal surgical management tailored to resource-limited populations.
This study highlights that diagnostic laparoscopy is a safe and effective modality for managing hollow viscus perforation in selected patients at a tertiary care hospital serving a tribal population. Compared to exploratory laparotomy, laparoscopy offers significant benefits such as reduced postoperative pain, shorter hospital stays, and lower incidence of surgical site infections without compromising surgical outcomes. While laparoscopy may require longer operative time and occasional conversion to open surgery, it contributes to enhanced postoperative recovery and patient comfort.
Exploratory laparotomy remains essential for patients presenting with extensive peritoneal contamination, hemodynamic instability, or where laparoscopic expertise and resources are limited. Given the unique challenges in tribal and resource-constrained settings, expanding laparoscopic capabilities could improve the overall surgical care quality and patient outcomes.
Further large-scale studies with longer follow-up are recommended to better define patient selection criteria, optimize surgical protocols, and assess long-term outcomes of minimally invasive surgery for hollow viscus perforations in similar healthcare settings.
Creative Commons License
Download PDF
Download XML