Adhesive Intestinal Obstruction In Children Research Articles

Лікування та профілактика спайкової кишкової непрохідності в дітей

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.

ПРОГНОЗИРОВАНИЕ РИСКА РАЗВИТИЯ СПАЕЧНОЙ НЕПРОХОДИМОСТИ КИШЕЧНИКА У ДЕТЕЙ В ЗАВИСИМОСТИ ОТ ГЕНОТИПА АЦЕТИЛИРОВАНИЯ

Objective. To determine the predictive value of the genetic polymorphism of the N-arylacetyltransferase-2 (NAT-2) gene for assessing the risk of postoperative adhesive intestinal obstruction in children. Methods. In all children (36 children with adhesive intestinal obstruction (main group) and 35 planned patients (comparative group)) the acetylation genotype was studied by detecting point mutations of the NAT-2 gene using allele-specific amplification method with analysis of apolymerase chain reaction-restrictionfragmentlengthpolymorphism. Results. The study of the frequency of mutations at position 481 revealed the greatest diversity of the studied variants of genotypes: 33.3% of the children of the main group were homozygous for the wild-type gene, 44.4% were heterozygotes, 22.2% of patients had a homozygous mutant gene. According to the NAT-2 * 6A genotype (G 590 - A), the majority of patients (55.6%) were heterozygotes, 44.4% were homozygotes with the wild-type of the gene. Not a single case of mutation at position 857 has been identified. Among the children of the main group, the share of «fast» acetylators was 69.4%, in the comparison group - 40.0% (χ<sup>2</sup>=6.215; p=0.013). The development of postoperative adhesive intestinal obstruction in children with the “fast” acetylation genotype occurred in the absence of clinical and anamnestic risk factors and was characterized by a greater severity and prevalence of intra-abdominal adhesive process (PAI was (14.8±1.8) and (8.1±2.4 ), respectively). Conclusion. The risk of developing postoperative adhesive complications in children can be done preventively by determining the genetic polymorphism of the N-acetyltransferase-2 gene. The risk group for developing adhesive intestinal obstruction is made up of children who are the carriers of NAT-2 alleles and correspond to the genotype of «fast» and «moderate» acetylation. Children who are «fast» acetylators have a more pronounced intra-abdominal adhesion process and a higher risk of complications associated with excessive adhesion even in the absence of other risk factors. What this paper adds N-acetyltransferase 2 (NAT2) gene polymorphism as a prognostic risk factor for the development of adhesive intestinal obstruction in children has been studied. Children as the carriers of the «fast» acetylator genotype have a higher risk of developing intra-abdominal adhesions and therefore require more comprehensive preventive measures at all stages of possible influence.

Non-operative Management of Adhesive Intestinal Obstruction in Children over a 12 year period at Waikato Hospital

Title: Non-Operative Management of Adhesive Intestinal Bowel Obstruction in Children over a 12year Period at Waikato HospitalIntroduction: Post-operative small bowel adhesions causing bowel obstruction is common in adults but is uncommon in the paediatric age group. The incidence of adhesive intestinal obstruction (AIO) requiring surgical intervention ranges between 2-8% in paediatric patients and majority would occur within the first 2 years after surgery.
 Aim: To review our experience at a tertiary centre in children under 15years who were admitted with adhesive intestinal obstruction over a 12 year time period and to compare this with other international reports
 Methodology: This retrospective case series study of all paediatric surgical patients (aged between 1-15 years) admitted with adhesive intestinal obstruction to Waikato Hospital over a 12 year time period were identified by ICD-10-AM codes. Their demographic variables, information of previous surgery and the admissions details including particulars of management were tabulated.
 Results: Out of 66 admissions, 10 were excluded and 56 admissions were analysed. 35 patients were successfully managed non-operatively and 21 patients proceeded for operative management (7 early and 14 late). Of the operative group, 3 underwent bowel resections (2 early and 1 late). There was no statistically significant difference between length of stay (LOS) among patients with non-operative and operative management. There was also no statistically significant difference between LOS among patients with early (≤24 hours) operative management and late (>24 hours) operative management. In assessing secondary aims, statistically significant differences in the time of presentation from initial surgery was noted for patients who underwent appendectomy who trended towards earlier presentation compared to other laparotomies.
 Conclusion: This study demonstrated that there could still be a role of non-operative management of children with adhesive bowel obstruction but decision on further management should be clearly defined within 24hours to prevent development of complications.

Surgical treatment?s possibilities of late adhesive intestinal obstruction in children.

Objectives: To study the adhesions prevalence in the abdominal cavity and to determine the possibilities of surgical treatment of Late Adhesive Intestinal Obstruction (LAIO) in children. Materials and Methods: 73 children were operated on for LAIO. 35 children were in a comparison group (comprehensive treatment by traditional methods) and 38 children were in the main group. In the main group was used an anti-adhesive solution which containing sodium hyaluronate and decamethoxin to prevent recurrence of Adhesive Intestinal Obstruction (AIO). The following surgical interventions were performed: Adhesiolysis, adhesiolysis and resection of the small intestine, adhesiolysis and making of the ileostomy, elimination of the cause without total adhesiolysis, elimination of the cause without total adhesiolysis and with resection of the small intestine, elimination of the cause without total adhesiolysis and with making of ileostomy. The Adhesion Process (AP) in the abdominal cavity was evaluated by the type of adhesions and their projection on the anterior abdominal wall. Results: The most common causes of LAIO were adhesive conglomerates (32.88%), moorings (23.28%) and visceral-visceral adhesions (21.92%) in lesser extent visceral-parietal and omentalvisceral adhesions, accordingly 10.96% and 10.96%. In main group recurrent AIO was seen in 3 of 38 children (7.89%) and resolved conservatively. In comparison group recurrent AIO occurred in 7 of 35 children (20%). In comparison group, 4 of 7 children required relaparotomy. The method of cause eliminating was used at AIO without total adhesiolysis using sodium hyaluronate for the operated children. When children were observed between 1 and 7 years, recurrence of AIO was in 1 patient who resolved conservatively. Conclusion: Mesothelium damaging leads to the emergence of the primary AP of the abdominal cavity with spreading to the surrounding structures and projection on the areas of the anterior abdominal wall. In operations for LAIO in children, it is advisable to use the operation of the cause eliminating (separation or resection of the conglomerates, cutting of the mooring) without total adhesiolysis in combination with intraoperative use of sodium hyaluronate solution with decamethoxine. Keywords Late Adhesion Intestinal Obstruction (LAIO), Children.

Active components of anti-adhesion therapy based on titanium nanoparticles

Introduction. The adhesion process of the abdominal cavity is a complex of body reactions in response to inflammatory processes in the abdominal cavity, trauma of the mesothelium during surgical interventions. Adhesive intestinal obstruction in children of the Sverdlovsk region remains significant in the structure of acquired intestinal obstruction. The actual direction in the treatment of adhesions in children is the use of nanoparticles of titanium glycerosolvate aquacomplex in combination with Lydase 128 U. Purpose of the study is to evaluate the results of treatment of adhesive intestinal obstruction in children of the Sverdlovsk region using the aqua-complex of titanium glycerosolvate with lidaza 128 U. Materials and methods. A retrospective analysis of the case histories of children treated in the emergency surgery department of the City Children's Clinical Hospital № 9 of Yekaterinburg from 2013 to 2018 was conducted. The total number of cases n = 92. All children were divided into groups depending on the disease that caused the obstruction. Results. When a commissural obstruction was suspected, all children were prescribed conservative therapy, which was successful in 41,3% of cases. In the absence of positive dynamics of conservative treatment, surgical treatment is indicated. Laparoscopy was performed in 28 of children and was successful in half the cases. Laparotomy was performed when it was impossible to eliminate obstruction with the minimally invasive method. The postoperative period proceeded without surgical complications with the use of anti-adhesion therapy using nanoparticles of the aqua-complex of titanium glycerosolvate in combination with lydasum 128 U. Conclusions . The multifactorial development of the adhesive process leads to the formation of adhesions. The choice of surgical treatment depends on the severity of adhesions. The use of the gel combination Tizol with lydasum 128 U is a modern method of anti-adhesive therapy in medicine.

Сучасні тенденції у профілактиці та лікуванні спайкової кишкової непрохідності у дітей (огляд літератури)

Сучасні тенденції у профілактиці та лікуванні спайкової кишкової непрохідності у дітей (огляд літератури)

Hyaluronic acid solution as a treatment of adhesive intestinal obstruction in children – A positive effect

Hyaluronic acid solution as a treatment of adhesive intestinal obstruction in children – A positive effect

The etiology and pathogenesis of adhesive intestinal obstruction in children (literature review)

В статті викладені етіологія та патогенез спайкової кишкової непрохідності у дітей на підставі огляду літературних джерел. Описано основні причини виникнення, фактори ризику, що впливають на розвиток ранньої та пізньої спайкової кишкової непрохідності у дітей. Зроблено висновок про те, що механізм спайкоутворення — це складний поліетіологічний процес, в якому антиадгезивні та адгезивні властивості очеревини знаходяться в реципрокних відношеннях. Їх дисбаланс прямо впливає на вираженість спайкоутворення. Тонка грань біологічної рівноваги відокремлює захисно-пристосувальний механізм від патологічного процесу спайкоутворення. У зв’язку з цим перед дитячими хірургами стоїть складне завдання розробки, освоєння та впровадження нових профілактичних заходів щодо запобігання розвитку спайкоутворення в черевній порожнині.

Modern Methods of Preventing Recurrent Adhesive Intestinal Obstruction in Children

Adhesive intestinal obstruction is one of the most urgent problems in pediatric abdominal surgery due to its high rate resulting in a lot of complications, recurrences and relaparotomies.The objective of the research was to examine the clinical efficacy of using intraoperative antiadhesive drugs in children to prevent recurrent adhesive intestinal obstruction.Materials and methods. The examination and analysis of medical records of 86 children with adhesive intestinal obstruction treated in the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University over the past 5 years was carried out. We identified two groups of patients: the comparison group included 40 children who received traditional treatment; the main group included 14 children who underwent the application of antiadhesive gel intraoperatively. The assessment of treatment effectiveness was carried out on the base of the postoperative course (recovery time of intestinal peristalsis, onset of enteral feeding, duration of hospital stay, incidence of early postoperative complications) and long-term outcomes (severity of adhesive disease symptoms, presence of recurrent adhesive intestinal obstruction and relaparotomies).Results and discussion. In comparative evaluation of the postoperative course in two groups of patients we noticed a more favorable course in children of the main group that was shown by faster recovery of peristalsis, reduced duration of gastric stasis, quicker occurrence of self-defecation and shortened term of hospital treatment. In the comparison group recurrent adhesive intestinal obstruction occurred in 8 (20.0%) patients, in 6 (15.0%) cases relaparotomy was performed. In the main group of patients, recurrent adhesive intestinal obstruction was observed in one (7.1%) child; however, relaparotomy was not performed.Conclusions. The intraoperative application of antiadhesive gel is a highly effective and safe way to prevent the recurrence of adhesive intestinal obstruction in children.

Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?

Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Adhesive intestinal obstruction accounted for 21 (8.8%) of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 +/- 6.4 years), comprising 13 males and eight females (ratio 1.6:1). Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%), perforated appendix (five, 23.8%), perforated volvulus (three, 14.3%), penetrating abdominal trauma (two, 9.5%) and perforated typhoid (two, 9.5%) were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6%) children due to poor response to nonoperative management, 11-13 days in 12 (57.1%) who responded minimally and 2-5 weeks in three (14.3%) who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%), multiple bands/adhesions (13, 61.9%) and encasement, including one bowel gangrene (six, 28.6%). Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and mortalities in settings with limited resources.

Microlaparoscopic treatment of adhesive intestinal obstruction in children

To evaluate the clinical significance of microlaparoscopic treatment for adhesive intestinal obstruction in children. Adhesion -lysis operation was performed in 18 patients with adhesive intestinal obstruct ion by microlaparoscope from March 2001 to January 2004. The clinical data were analyzed retrospectively. Microlaparoscope assisted accretion-lysis operation was successfully performed in all patients. The operative time ranged from 15 min to 45 min (averaged 30 min), the aerofluxus time ranged from 12 hours to 28 hours (averaged 22 hours) after operation. All patients can take general activity at the first day and take in food at the second day after operation respectively. The hospital stay ranged from 3 to 5 days (averaged 4 days) without complications. All patients were followed-up from 3 months to 18 months (average d 6 months). All patients recovered well without occurrence of adhesive intestinal obstruction. Micro-laparoscope assisted adhesion-lysis operation is a simple,safe,and feasible approach for adhesive intestinal obstruction in children.

A Study of Postoperative Adhesive Intestinal Obstruction in Children

A Study of Postoperative Adhesive Intestinal Obstruction in Children