Acute Adhesive Small Bowel Obstruction Research Articles

Пути оптимизации лечебно-диагностической тактики при острой спаечной обтурационной тонкокишечной непроходимости

Пути оптимизации лечебно-диагностической тактики при острой спаечной обтурационной тонкокишечной непроходимости

Пути оптимизации лечебно-диагностической тактики при острой спаечной обтурационной тонкокишечной непроходимости

Пути оптимизации лечебно-диагностической тактики при острой спаечной обтурационной тонкокишечной непроходимости

PWE-268 A systematic review comparing laparoscopic versus open adhesiolysis in patients with adhesional small bowel obstruction

Introduction The objective of this article is to evaluate whether surgical outcomes differ between laparoscopic versus open approach for adhesiolysis in patients presenting with adhesional small bowel obstruction (ASBO). Method A systematic review of literature on published comparative studies reporting the surgical outcomes following laparoscopic versus open adhesiolysis for ASBO was undertaken using the principles of meta-analysis. Results Ten retrospective comparative studies on 37,038 patients evaluating the surgical outcomes in patients undergoing laparoscopic versus open adhesiolysis for ASBO were systematically analysed. There were 31778 patients in open group and 5260 patients in laparoscopic group. Laparoscopic adhesiolysis resulted in the reduced risk of post-operative complications [odds ratio, 0.36 (CI, 0.28–0.46), p < 0.00001], post-operative mortality [odds ratio, 0.31 (CI, 0.23–0.42), p < 0.00001] and surgical site infections [odds ratio, 0.22 (CI, 0.12–0.43), p < 0.00001]. In addition, the risk of respiratory complications, cardiac complications, bowel resection, post-operative ileus, venous thromboembolism [odds ratio, 0.36 (CI, 0.24–0.53), p < 0.00001] and infective complications [odds ratio, 0.41 (CI, 0.34–0.49), p < 0.00001] was also lower in patients undergoing laparoscopic adhesiolysis. Length of hospital stay was statistically shorter in laparoscopic group. However, statistical equivalence was seen in variables of re-operation rate, duration of operation and risk of neurological complications. There was significant heterogeneity among included studies. Conclusion Laparoscopic adhesiolysis for ASBO seems to have clinically proven advantage over open approach in terms of several operative and post-operative outcomes measures in patients whom the procedure was considered feasible. Disclosure of interest None Declared.

Acute early adhesive small bowel obstruction: today`s possibilities of laparoscopy in diagnosis and treatment

Acute early adhesive small bowel obstruction: today`s possibilities of laparoscopy in diagnosis and treatment

Laparoscopic diagnostics and treatment of acute early adhesive small bowel obstruction after gynecological operations performed by laparoscopic access

The Results of treatment of 8 female patients with early acute adhesive small bowel obstruction (AASBO) after laparoscopic gynecological surgery are presented. Diagnostic laparoscopy appeared to be the most helpful and the safest diagnostic technique, confirming the AASBO diagnosis and helping to choose operative treatment mode. In 5 patients AASBO was successfully treated using laparoscopic method, while in 3 patient median laparotomy was required: 1 patient with AASBO relapse, and 2 patients with pelvic peritonitis progression.

Laparoscopic treatment of acute adhesive small bowel obstruction compared with conventional method

Abstract: Intestinal obstTUction is an abdominal emergency, and it is a common reason for surgical referral. There are many studies that demonstrated the feasibility of laparoscopy in management of acute adhesive small bowel obstruction. Although laparoscopy is a good technique for many intra-abdominal operative procedures, laparoscopy was contraindicated in abdominal surgical emergency, and intestinal obstTUction. It remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from this technique or not. 104 patients were included in this study and were divided into two groups, each group included 52 patients. Each group was treated by one surgical technique from those mentioned above and the results were compared with each other. Complete laparoscopic treatment was performed in 25 patients (48.1%). Major intra-operative complications occurred in 15 patients in the LAP group and 8 patients in CONV group (p= 0.156). Intra-operative perforations were more frequent inpatients who had more than one previous laparotomy (P=O.066). Postoperative complications occurred in 10 patients (19.2%) in the LAP group and in 21 patients (40.4%), who had conventional surgery (P=0.032). Bowel movements started 3.5 days after operation in the LAP group, and 4.4 days after conventional operation (P=O.001). The length of hospital stay was 11.3 and 18.1 days respectively (P=0.001). From this study we can conclude than laparoscopic treatment of acute SBO was feasible in about half of these patients, morbidity is lower, hospital stay is shorter than patients with open surgery, and postoperative recovery and resumption of a normal diet is faster, but the risk of intra-operative complications increased. A laparoscopic approach seems justified in subset of patients.

The acute adhesive small-bowel obstruction timing of surgical intervention、 indications and prognosis

Objective To investigate the acute adhesive small-bowel obstruction timing of surgical intervention、indications and prognosis. Methods A retrospective analysis of 48 cases of acute adhesive smallbowel obstruction of the clinical data, surgical timing and indications, which were treated from January 2000 to July 2009.Results 41 patients cured,5 cases improved, two deaths from septic shock, postoperative pulmonary infection in 10 cases,8 cases of wound infection, intra-abdominal residual abscess in 5 cases, short bowel syndrome in 3 cases,2 cases of renal insufficiency, which were cured through combined treatment. Conclusion Acute adhesive intestinal obstruction in a conservative course of treatment should be to discover clues of early intestinal strangulation, decisive decision to surgical treatment, timing of surgery are advised to be early, not late.Being loose instead of strict in surgical indications is the important measures to improve the clinical cure rate and reduce complications and mortality. Key words: Acute adhesive small intestinal obstruction; Surgical timing ; Surgical indication

Improving the Management of Acute Adhesive Small Bowel Obstruction with CT-Scan and Water-Soluble Contrast Medium: A Prospective Study

Improving the Management of Acute Adhesive Small Bowel Obstruction with CT-Scan and Water-Soluble Contrast Medium: A Prospective Study

Improving the Management of Acute Adhesive Small Bowel Obstruction with CT-Scan and Water-Soluble Contrast Medium: A Prospective Study

Adhesive small bowel obstruction is usually managed nonoperatively, but there is still debate over the optimal duration of nonoperative management and the factors that predict failure of medical treatment. The aim of this study was to evaluate an algorithm using CT-scans and Gastrografin in the management of small bowel obstruction. In a prospective study, each patient admitted for small bowel obstruction underwent a physical examination, a plain film, and a CT-scan evaluation. Patients underwent emergency surgical exploration when bowel ischemia was suspected. Other patients received oral Gastrografin, and a second plain abdominal radiograph was done after 12 hours. In patients with clinical improvement, the nasogastric tube was removed and an immediate liquid diet was resumed. Other patients were referred for surgery. In total, 118 patients with 123 episodes of small bowel obstruction were included. Thirty-six (29%) required immediate surgery because they presented clinical characteristics of bowel ischemia (36/36; 100%) or a defect in vascularization of the small bowel on CT-scan (5/36; 14%). The 87 remaining patients were managed nonoperatively, of which 28 deteriorated and were referred for surgery. The 59 other patients showed clinical improvement. This study demonstrated the diagnostic role of Gastrografin(R) in discriminating between partial and complete small bowel obstruction. CT-scans were disappointing in their ability to predict the necessity of emergent laparotomies. We therefore recommend the use of Gastrografin(R) in adhesive small bowel obstruction patients who do not have clinical evidence of bowel ischemia. CT-scans should not be routinely performed in the decision-making process except when clinical history, physical examination, and plain film are not conclusive for small bowel obstruction diagnosis.

Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital

The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery. Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients). Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique. A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.

Selective Laparoscopic Management of Adhesive Small Bowel Obstruction Using CT Guidance

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.

Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness

Numerous studies have demonstrated the feasibility of laparoscopy in the management of acute adhesive small-bowel obstruction (AASBO). However, comparative data with laparotomy are lacking. The aim of this study was to compare laparoscopy and laparotomy for the treatment of AASBO in terms of patient outcome and cost-effectiveness. A retrospective chart review of all patients who underwent surgery for AASBO from 1999 to 2005 was conducted. Data recorded included operative and postoperative course, among others. Operative and total hospital charges were estimated from the Patient Accounting System. Thirty-one patients who underwent laparoscopy were matched to a similar group of patients who underwent laparotomy. In the laparoscopy group, four patients (13%) had a laparoscopy-assisted procedure and ten patients (32%) were converted. The laparoscopy group was subdivided into laparoscopy, laparoscopy-assisted, converted, and assisted-converted subgroups. In the majority of the patients, AASBO was secondary to a single band. Overall morbidity was significantly higher in the laparotomy group (p = 0.007). Morbidity rates were statistically significant between the laparoscopy and assisted-converted subgroups (p = 0.0001) but not between the laparotomy group and assisted-converted subgroup (p = 0.19). Median hospital stay and median time to first bowel movement were significantly shorter in the laparoscopy group. Charge data were available for only the last three years of the study. Operative charges and total hospital charges were similar between the laparoscopy and the laparotomy groups (p = 0.14 and p = 0.10, respectively). There was a significant difference in total hospital charges between the laparoscopy subgroup and laparotomy group (p = 0.03). Laparoscopy for AASBO is associated with reduced hospital stay, early recovery, and decreased morbidity. Laparoscopy-assisted and converted surgeries do not differ significantly from laparotomy in regard to patient outcome. Operative and total hospital charges are similar for both laparoscopy and laparotomy.

Laparoscopic management of adhesive acute postoperative small bowel obstruction

Laparoscopic management of postoperative acute adhesive small bowel obstruction (SBO) may often have clinical advantages. This prospective study included patients with postoperative acute SBO in whom sufficient intestinal decompression was achieved using a nasoenteric ileus tube preoperatively, but pass disorder was not improved. This study describes our experience with the laparoscopic procedure for patients with adhesive acute SBO. The laparoscopic approach was undertaken in 24 of 51 patients admitted for acute postoperative SBO from July 1994 through June 2000; it was performed successfully in 20 patients (83%), and four cases were converted to open surgery (17%) because of strong adhesions. In four patients with gallstones and inguinal hernia, laparoscopic surgery (cholecystectomy, hernioplasty) was performed simultaneously. There was no mortality and low morbidity (4.1%). The group of patients treated laparoscopically had a shorter hospital stay than the conventional open group (12 versus 21 days; p < 0.05). At the median follow-up of 84 months, 21 of the 22 patients who had received laparoscopic procedure remained asymptomatic. Laparoscopic treatment was effective, involved a shorter hospital stay and has shown good long-term results for most patients with adhesive acute SBO.

Diagnosis and management of small intestinal diseases

Topics related to the diagnosis of small intestinal diseases that are covered in this review include a potential new serum marker for intestinal infarction; an improved diagnostic test for Whipple's disease; diagnostic enteroscopy; the use of marker studies to help diagnose and localize the site of partial small bowel obstruction; and the use of a color card to help localize the source of rectal bleeding. Treatment topics include the use of urokinase for acute superior mesenteric vein or portal vein thrombosis; the use of nasogastric versus long intestinal drainage tubes for acute adhesive small bowel obstruction; guidelines for the use of octreotide to treat secretory diarrhea; and the use of patient-controlled analgesia pumps after uncomplicated colonic surgery and postoperative ileus.

A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction

Background: Many cases of acute adhesive small-bowel obstruction (SBO) can be successfully treated with intestinal tube decompression. There is considerable controversy, however, regarding whether a short nasogastric tube (NGT) or a long nasointestinal tube (LT) is the best method of intestinal tube decompression. Patients and methods: A prospective, randomized trial was conducted to compare NGT and LT decompression with respect to the success of nonoperative treatment and morbidity of surgical intervention in 55 patients with acute adhesive SBO. Results: Twenty-eight patients were managed with NGT and 27 with LT. There were 44 cases of partial SBO (23 NGT, 21 LT) and 11 cases of complete SBO (5 NGT, 6 LT). Twenty-one patients ultimately required operation, including 13 managed with NGT (46%) and 8 with LT (30%) ( P = 0.16). The mean period between admission and operation was 60 hours in the NGT group versus 65 hours in the LT group. At operation, 3 patients in the NGT group had ischemic bowel that required resection. Postoperative complications occurred in 23% of patients treated with NGT versus 38% of patients treated with LT ( P = 0.89). Postoperative ileus averaged 6.1 days for NGT patients versus 4.6 days for LT patients ( P = 0.44). There were no deaths. Conclusions: Patients with adhesive SBO can safely be given a trial of tube decompression upon hospital admission. There was no advantage of one type of tube over the other in patients with adhesive SBO.