ПРОФИЛАКТИЧЕСКИЕ МЕРОПРИЯТИЯ КАК ОБЯЗАТЕЛЬНЫЙ КОМПОНЕНТ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ОСТРОЙ СПАЕЧНОЙ КИШЕЧНОЙ НЕПРОХОДИМОСТЬЮ

Abstract

Objective. Reducing the recurrence rate of adhesive disease after its surgical treatment by developing a differentiated approach to preventive measures. Methods. A retrospective study included patients (n=260) with adhesive disease complicated by recurrent attacks of acute bowel obstruction has been performed. The main (n=105) and control (n=155) groups were formed. The patients of the main group were undergone to algorithmfor prophylaxisandtreatment in patients providing the implementation of planned surgical treatment and measurestoprevent recurrence. The nature of preventive measures was determined by the volume of surgical trauma of the peritoneal mesothelium and the prevalence of cicatricial-adhesive changes. In the control group, patients underwent standard measures aimed at conservative resolution of acute adhesive bowel obstruction: depending on their effectiveness, patients were discharged for further outpatient treatment or for urgent surgical intervention without any preventive measures. The primary outcome was considered to be the incidenceandrecurrencerate of adhesive disease and the severity of clinical symptoms, which were traced to a depth from 2 to 10 years by interviewing patients. If it was impossible to assess long-term results, patients were excluded from the study. Results. The total frequency of adhesive disease relapses requiring hospitalization was 8.6% (n=9) in the main group and 27.1% (n=42) in the comparison group, respectively. The best results were obtained in the subgroup of patients operated on for adhesive disease in a planned manner - the frequency recurrence rate was 4.6%. Conclusion. The use of the developed therapeutic and prophylactic algorithm in the surgical treatment of adhesive disease led to decline in relapse ratesfrom 27.1 %-8.6% cases of an improvement of life quality of patients with acute adhesive intestinal obstruction who underwent surgical treatment. What this paper adds The differentiated approach to the choice of operative access and surgical treatment of adhesive bowel obstruction has been developed. Indications for the use of specific preventive measures, depending on operative access and the nature of the surgical intervention have been substantiated.