METHODS OF SURGICAL INTERVENTIONS FOR ACUTE INTESTINAL OBSTRUCTION AND PERULICARITIES OF POSTOPERATIVE MANAGEMENT

Abstract

The aim of the study was to investigate the characteristics of surgical interventions and the features of the postoperative period in patients with acute intestinal obstruction. Materials and methods. The study was based on the results of treatment of 154 patients with acute benign intestinal obstruction, who underwent various types of surgical interventions for this pathology. There were 87 men (56.5%) and 67 women (43.5%), their age ranged from 18 to 78 years; most of the patients were residents of Baku (124 patients, 80.5%), 30 patients (19.5%) were residents of the regions of the Azerbaijan Republic. Results. Sigmoid colon resection was performed on in 25 patients (16.2% of cases); resection of various parts of the small intestine was performed on in 26 patients (16.9% of cases). To determine the boundaries of viable parts of the intestine and the extent of resection in the patients, the common and classical criteria were used: pulsation of the mesentery vessels, the presence of peristalsis, and colour of the serous covering after warming of an intestinal segment of questionable viability with hot wet wipes. Hagen-Thorn surgery was usually performed on in elderly patients with acute intestinal obstruction as a result of sigmoid colon inversion that made up 8.4% of all operations performed. Subtotal colectomy with ileorectoanastomosis was performed on in 7 patients (4.6% of cases). Operations of the Hartmann type despite the aetiology were performed in 31 patients (20.1% of cases). Right-sided hemicolectomy with ileotransverse anastomosis was performed in 4 patients (2.6% of cases). Enterotomy with the removal of stones or foreign bodies followed by suturing of the defect in the intestinal wall was performed in 5 patients (3.3% of cases).All the patients were subject to one of the main stages of intra-abdominal intervention – the simultaneous intraoperative decompression of the intestinal tract by evacuating the contents using one of the generally accepted standard techniques (by using intestinal tube, emulging, enterotomy, etc.). Conclusions. Although the duration of the preoperative preparation itself was individual for each patient and depended on the specific circumstances, in general, it was 3.6±0.8 hours in the patients with acute intestinal obstruction. During this short time, infusion therapy was performed on in all patients, a nasogastric tube was also inserted to all patients and, when possible, more stagnant contents were emulged out of the upper digestive tract. Cardiac functioning was corrected when necessary; the measures to reduce the intensity of intoxication, including antibacterials, were performed. In special cases, during the short-term preoperative preparation of the patients, additional medication correction of concomitant diseases was mandatory. To prevent the development of thromboembolic complications in the early postoperative period, all patients were required to take the necessary preventive measures before and after the surgical intervention.