scholarly journals Acute adhesive small-bowel obstruction: laparotomy or laparoscopy

2018 ◽  
Vol 99 (3) ◽  
pp. 508-514
Author(s):  
I S Malkov ◽  
E B Bagautdinov ◽  
I F Sharafislamov ◽  
S R Zogot ◽  
Dz Kh Misiev
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Methods ◽  
Abdominal Pressure ◽  
Adhesive Small Bowel Obstruction ◽  
Diffuse Peritonitis ◽  
Laparoscopic Adhesiolysis ◽  
Radiological Methods

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment. Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders. Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy). Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

scholarly journals Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

2021 ◽  
Vol 12 (4) ◽  
pp. 47-54
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Sergey V. Petrov ◽  
Diyora H. Qalandarova
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Small Bowel ◽  
Mortality Rate ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Adhesive Small Bowel Obstruction ◽  
Surgical Interventions

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

Selective Laparoscopic Management of Adhesive Small Bowel Obstruction Using CT Guidance

2009 ◽  
Vol 75 (3) ◽  
pp. 227-231 ◽  
Author(s):  
In Kyu Lee ◽  
Do Hyoung Kim ◽  
D. Lee Gorden ◽  
Yoon Suk Lee ◽  
Seung Eun Jung ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Medical Center ◽  
Preoperative Imaging ◽  
Adhesive Small Bowel Obstruction ◽  
Abdominal Ct ◽  
Laparoscopic Adhesiolysis ◽  
Adhesive Band

Small bowel obstruction after intra-abdominal surgery is a common cause of morbidity necessitating reoperation. The aim of this study was to determine the feasibility of and indications for laparoscopic surgery for acute adhesive small bowel obstruction (AASBO). We conducted a retrospective review of all patients with AASBO who underwent laparoscopic adhesiolysis at a major university medical center. Laparoscopic treatment was performed successfully in 16 patients, and conventional treatment was performed in 13 patients. The rate of conversion from laparoscopic to open was 16.7 per cent. In 15 of 16 total patients who underwent laparoscopic surgery, laparoscopic bandlysis was performed and one patient underwent laparoscopic adhesiolysis. Laparoscopic surgery was performed successfully in nine who had a single adhesive band demonstrated on an abdominal CT, and conventional surgery was performed in all 10 patients without a single adhesive band identified radiographically. Abdominal CT scans facilitate the selection of operative approach for AASBO based on preoperative identification of the obstruction site. Laparoscopic adhesiolysis is a safe and effective treatment modality for patients with AASBO with a single band or single transition zone identified by preoperative imaging.

scholarly journals Laparoscopic Adhesiolysis - An Initial Experience of 15 Cases

2010 ◽  
Vol 15 (Number 2) ◽  
pp. 3-8
Author(s):  
B U Khan ◽  
A Azim ◽  
S Baemon ◽  
S I Khan
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Chronic Abdominal Pain ◽  
High Rate ◽  
Adhesive Small Bowel Obstruction ◽  
Surgical Trauma ◽  
College Hospital ◽  
Laparoscopic Adhesiolysis

Post-operative adhesions frequently occur and can account for various symptoms like chronic abdominal pain and small bowel obstruction. Conventional adhesiolylis by laparotomy results in an unacceptably high rate of recurrence. A minimally invasive procedure (laparoscopic adhesiolysis) might improve she outcome by inflicting less surgical trauma, but well-documented reports focusing on laparoscopic adhesiolysis for chronic abdominal pain and small bowel obstruction is lacking. The aim of this study was to evaluate the efficiency. safety. and outcome of laparoscopic adhesiolysis for recurrent adhesive small-bowel obstruction. Eighty nine patiencs (median age 48 years: range: 25-83 years) operated for small bowel obstruction and chronic abdominal pain in the Depanment of General Surgery, Holy Family Red Crescent Medical College hospital were included for the study. Pre-pensive urgent blood teas and ubdontinal s- ay were done in all patients; 74 patients were treated with traditional laparotomy, while 15 selected patients underwent laparoscopy. For one (6.67%) of the 15 patients treated wits laparoscopy a conversion was necessmy because of the adhesion localization in the posterior abdominal wall, The median stay in hospital was 4.7 days for patients who underwent laparoscopy and 14.3 days for patients treated by traditional laparotonsy. Only one (6.67%) case in laparoscopv group needed to be re-operated, while five (6.76%) cases in laparntonty group needed to be re-operated because of recurrence of obstruction by new adhesions. Overall number of complications contributing to morbidity were significantly lower in those who underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is an effective treatment for small bowel obsommion, morbidity is lower. hospital stay is shorter. and resumption of a novael diet is foster.

FEATURES OF DIAGNOSIS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION

2021 ◽  
pp. 33-38
Author(s):  
Б.В. Сигуа ◽  
В.П. Земляной ◽  
С.В. Петров ◽  
Д.Х. Каландарова ◽  
А. Л. Ефимов
Keyword(s):  
Small Bowel ◽  
Mortality Rate ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Comparison Group ◽  
Treatment Algorithm ◽  
Diagnostic Algorithm ◽  
Main Group ◽  
Diagnostic Methods ◽  
Adhesive Small Bowel Obstruction

Спаечная тонкокишечная непроходимость является часто встречающейся патологией с тенденцией к нарастанию, характеризуется сложным патогенетическим течением, с высоким процентным соотношением осложнений и летальных исходов. Среди форм кишечной непроходимости, обусловленных механическим препятствием, острая тонкокишечная непроходимость составляет 64,3-80 % с летальностью 5,1-8,4 % в структуре ургентных заболеваний. Сложность ранней диагностики наряду со стертой клинической картиной, тяжелым течением на отягощенном фоне у лиц пожилого и старческого возраста ведет к поиску новых оптимизированных лечебнодиагностических протоколов. Цель исследования - изучение характера течения спаечной тонкокишечной непроходимости у лиц пожилого и старческого возраста, установление информативности различных методов диагностики, определение показаний к выбору оптимального срока и метода лечения. Проведен сравнительный анализ по результатам лечения 191 пациента 60-90 лет и старше, получавших лечение в хирургических отделениях Елизаветинской больницы (Санкт-Петербург) в период 2016-2019 гг. Все пациенты были разделены на две группы: основную составили 106 пациентов (2018-2019 гг.), группу сравнения - 85 пациентов (2016-2017 гг.). Для всех пациентов основной группы использован усовершенствованный лечебно-диагностический алгоритм с применением оригинальной балльно-оценочной шкалы, который позволил оптимизировать диагностику и улучшить результаты лечения. Пациенты группы сравнения были обследованы в соответствии со стандартными протоколами, оперативное лечение осуществляли исключительно традиционными методами. Применение предложенного лечебно-диагностического алгоритма позволило увеличить вероятность консервативного разрешения острой спаечной тонкокишечной непроходимости с 20 % (17) до 33 % (35), снизить частоту послеоперационных осложнений с 60,2 % (41) до 25,3 % (18), р<0,01, а уровень летальности - с 23,5 % (16) до 7 % (5), р<0,05. Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80 % with a mortality rate of 5,1 to 8,4 % in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20 % (17) to 33 % (35) and to reduce the incidence of postoperative complications from 60,2 % (41) to 25,3 % (18), p<0,01, and the mortality rate from 23,5 % (16) to 7 % (5), p<0,05.

scholarly journals Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score–Matched Analysis

2016 ◽  
Vol 106 (1) ◽  
pp. 28-33 ◽  
Author(s):  
T. Hackenberg ◽  
P. Mentula ◽  
A. Leppäniemi ◽  
V. Sallinen
Keyword(s):  
Small Bowel ◽  
Propensity Score ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Open Surgery ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Adhesive Small Bowel Obstruction ◽  
Open Approach ◽  
Laparoscopic Adhesiolysis

Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien–Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score–matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score–matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score–matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.

Laparoscopic Management of Adhesive Small Bowel Obstruction

2007 ◽  
Vol 73 (8) ◽  
pp. 773-779 ◽  
Author(s):  
Marc Zerey ◽  
Catherine W. Sechrist ◽  
Kent W. Kercher ◽  
Ronald F. Sing ◽  
Brent D. Matthews ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Laparoscopic Approach ◽  
Western World ◽  
Adhesive Small Bowel Obstruction ◽  
Intraoperative Complication ◽  
Working Space ◽  
Laparoscopic Adhesiolysis ◽  
Procedural Time

Adhesions from prior surgery are the most common cause of small bowel obstruction (SBO) in the Western world. Although laparoscopic adhesiolysis can be performed safely and effectively, the indications and contraindications to the use of laparoscopic techniques in SBO are not clearly defined. The goal of our study was to determine the outcomes of the laparoscopic approach to SBO and discuss patient considerations for its utilization. We retrospectively surveyed all patients undergoing laparoscopic or attempted laparoscopic adhesiolysis performed by the authors between July 1997 and March 2006. Data obtained included patient demographics, clinical and radiologic presentation, and intraoperative and postoperative course. Thirty-three patients underwent laparoscopic adhesiolysis secondary to a SBO. Mean age was 53.6 years (range, 29–84 years) and 64 per cent (21 of 33) were female. Mean body mass index was 30.0 kg/m2 (range, 22.6–46.1 kg/m2). Thirty-one patients (93.9%) had undergone between one and four abdominal surgeries and seven (21.2%) had a previous episode of SBO. There were no patients with peritonitis. Abdominal CT scan was performed preoperatively in 27 patients (81.8%). Laparoscopy diagnosed the site of obstruction in all patients. Twenty-nine patients (88%) were successfully treated laparoscopically. Conversion to laparotomy was required in four cases as a result of dense adhesions and/or a lack of working space. Mean procedural time was 101 minutes (range, 19–198 minutes). There was one intraoperative complication (enterotomy), which was repaired laparoscopically and did not require conversion. Conversion was associated with significantly increased procedural time (129 versus 93 minutes; P = 0.02), but not blood loss or complications. Average times to passage of flatus and first bowel movement were 2.3 days (range, 0.5–5 days) and 3.2 days (range, 1–6 days), respectively. Seven patients (21.2%) had postoperative complications, including wound infection, urinary tract infection, and acute renal insufficiency, all of which occurred in patients completed laparoscopically. One patient had a recurrent SBO 8 months postoperatively managed by repeat laparoscopic lysis of adhesions. Mean postoperative stay was 6 days (range, 1–19 days). There was no hospital mortality. Laparoscopy is safe and feasible in the management of acute SBO in selected patients. It is an excellent diagnostic tool and is therapeutic in most cases.

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