Лікування та профілактика спайкової кишкової непрохідності в дітей

Abstract

Despite the achievements of modern pediatric surgery, to date there is no single comprehensive approach to the treatment and prevention of adhesive intestinal obstruction (AIO), both primary (prevention of adhesions formation after primary surgery) and secondary (prevention of recurrence). Purpose - to study the clinical effectiveness of treatment, primary and secondary prevention of postoperative intestinal adhesive obstruction in children. Materials and methods. An examination and analysis of medical records of 119 children aged 5 months to 17 years who were treated at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University over the past 10 years for post-operative AIO was carried out. In 35 (29.41%) children a positive effect was achieved from conservative treatment. The remaining 84 (70.59%) children were operated on. Two groups of patients were formed: the comparison group - 38 (45.24%) children, who received traditional treatment, and the main group - 46 (54.76%) children, who were intraoperatively applied anti-adhesive gel to prevent recurrence of postoperative AIO. Results. It was established that postoperative AIO occurred in only 1 (1.19%) child after laparoscopic intervention, in the rest of the children primary surgical interventions were performed by an open method. In the comparative assessment of the postoperative course in two groups of patients, we drew attention to a more favorable course in the children of the main group, which was manifested by a faster recovery of peristalsis, a decrease in the duration of gastric stasis, a faster appearance of independent defecation, and a shorter period of inpatient treatment. When comparing the results of treatment between groups of patients, it was established that the frequency of recurrences of AIO in the main group of patients was 5.44 times lower than in children of the comparison group, and the frequency of relaparotomy for recurrent AIO was 7.28 times lower than in patients of comparison group. We did not observe complications associated with the use of anti-adhesive gel. We did not notice a significant difference in the results of treatment between patients who were treated with anti-adhesive gel of different composition (based on carboxymethylcellulose and sodium hyaluronate). Conclusions. The most effective method of primary prevention of postoperative adhesive intestinal obstruction is the use of laparoscopic primary surgical interventions. Intraoperative application of anti-adhesive gel is a highly effective and safe recurrence prevention method of adhesive intestinal obstruction in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.