Adhesive Intestinal Obstruction Research Articles

ЭНДОХИРУРГИЧЕСКИЕ ТЕХНОЛОГИИ ЛЕЧЕНИЯ БРОНХОЛЕГОЧНОЙ СЕКВЕСТРАЦИИ У ДЕТЕЙ

The study systematized the long-term experience of thoracoscopic and laparoscopic treatment of intra- and extrapleural forms of bronchopulmonary sequestration (BPS). Materials and methods of research: a retrospective study analysed clinical data of 20 patients with BPS who have underwent thoracoscopic and laparoscopic surgeries for 15 years, starting from 2005. The main surgical methods included thoracoscopic lobectomy, thoracoscopic sequestrectomy, laparoscopic sequestrectomy and combined thoracoscopic transdiaphragmatic access in a patient with multiple forms of BPS. Results: a total of 20 patients with BPS had an intralobar form, 5 had an extralobar form, 4 had an extrapleural type, and 1 had a combined (extralobar + extrapleural) form. Intralobar form of BPS was found in the left lower lobe in 6 patients, in the right lower lobe – in 4. Extralobar BPS was found near the left lower lobe in 3 patients, near the lower right lobe – in 2. Extrapleural BPS was observed in the abdominal cavity under the diaphragm in 3 patients, in one patient – in the thickness of the diaphragmatic muscle. One patient had a combined form of BPS in the form of an association of extralobaric and intra-abdominal types. Thoracoscopy was performed in 16 patients, laparoscopy in 4 patients. The mean operative time was 60 min (range: 40–100 min). Intraoperative blood loss was not observed. A drainage tube was installed in 10 patients with intralobaric BPS. In all other cases, the pleural and abdominal cavity was not drained. A histological examination of all resected pulmonary sequesters showed that in half of the cases (10/20) the anomaly was associated with other malformations of the lungs (cystoadenomatous malformation of the lungs, bronchogenic cyst or intestinal duplication). During the 5 year average observation period after surgery (range: 1–15 years), musculoskeletal deformities of the chest and adhesive intestinal obstruction were not recorded. Conclusion: the series of minimally invasive treatment of patients with BPS presented in this study demonstrates the effectiveness and safety of this approach, especially for the surgical correction of those forms of pulmonary sequestration when they are located in hard-to-reach anatomical spaces of the body.

BIOMATERIALS BASED ON CHITOSAN AND ITS DERIVATIVES TO PREVENT ADHESION FORMATION

An increase in the number and volume of surgical interventions leads to an increase in the frequency of postoperative adhesions. The development of the adhesion process in the abdominal cavity causes pain, a decrease in the quality of life of patients, a violation of the reproductive function of women as well as acute adhesion intestinal obstruction. Recently, polymer biomaterials, including those based on chitosan, have been widely used for the prevention of adhesions. Due to their biocompatibility and biodegradation ability, they do not require repeated operations to extract the material. It is believed that these materials act as barriers, physically separating the damaged surfaces. The molecular mechanism of their action is still poorly understood. In this review, the main mechanisms of adhesion formation, as well as ways to prevent them with the help of materials based on chitosan and its derivatives, are discussed.

Еволюція діагностики та хірургічного лікування хворих на інтраабдомінальні інфільтрати й абсцеси первинного та післяопераційного походження

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. 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 these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

Congenital adhesion bands causing distal duodenal obstruction in a 6-year old child

A congenital adhesion band is a rare condition, but may induce small bowel obstruction at any age. Only a few sporadic case reports exist. We report a 6 -year- old boy with failure to thrive who presented with symptoms of high small bowel obstruction, absolute constipation of one week duration. He was managed successfully by division of congenital adhesion bands running across the third part of the duodenum. A good result can be expected in a late presentation of a congenital adhesive intestinal obstruction if early diagnosis and prompt management is pursued.

The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice.

Comparison between Tran abdominal and trans anal one stage pull through in Hirschsprung disease

Background: Hirschsprung’s disease (HD) is one of the commonly studied diseases among pediatric surgeons and researchers. It is also known as intestinal aganglionosis, which is a kind of birth defects mainly expressed as partial or complete absence of ganglion cells of the intestinal tract. Objective: The aim of the current work was to evaluate the management of children with Hirschsprung's disease by one stage pull-through Soave procedures (transanal and trans-abdominal one stage pull-through) concerning perioperative, short term outcomes and complications. Patients and methods: This randomized controlled trial study included a total of 32 patients subjected to transanal and transabdominal one stage pull-through procedures for management of Hirschsprung’s disease. Patients were recruited from the Inpatient Clinic, Pediatrics Surgical Department, Assiut University Hospitals. This study was conducted between April 2015 to March 2019 and followed up at our clinics. Results: Comparison of the rates of late post-operative complications among the studied groups revealed that regarding post-operative incontinence, group A had statistically insignificant (p = 0.723) lower rates (50%) compared with group B (56%). Likewise, rates of adhesive intestinal obstruction were insignificantly (p = 0.310) higher (6.2%) in comparison with group B (0%). There was statistically significant (p = 0.001) longer duration of hospital stay among patients in group A (11.1 ± 6.4days) compared with patients in group B (5.0 ± 1.4 days). Conclusion: It could be concluded that the advantages of TERPT include a good cosmetic effect, short hospital stays, safe, and less surgical site infection compared to transabdominal procedures.

Postoperative poor oral intake after open distal pancreatectomy

Besides the causes we know including adhesive ileus, it is not uncommon for poor oral intake (POI) in patients after distal pancreatectomy (DP). This study investigated the occurrence of POI and identify the risk factors of POI in patients after DP. In this retrospective study, prospectively collected data of patients who received DP in National Cancer Center, Korea between April 2013 and December 2020 were reviewed. The diet protocol after DP in our institution as follows; sips of water (SOW) on postoperative day (POD) 1, soft blended diet (SBD) on POD 2 or 3, and normal regular diet (NRD) after POD 5, if the patient was tolerable on diet protocol. POI after distal pancreatectomy was defined as the delay of postoperative diet protocol after DP or the reverse of postoperative diet progression sequence. A total of 148 patients received open distal pancreatectomy during the study period. Patients who were diagnosed adhesive ileus were excluded (n = 14), and finally 134 patients were enrolled. Including 7 patients with postoperative delayed gastric emptying, 39.2 (52/134)% patients experienced POI after distal pancreatectomy. multi-visceral resection (HR 2.901, 95% CI 1.041-8.085, p = 0.042), celiac axis resection (HR 12.369, 95% CI 1.113-137.451, p = 0.041), operation time > 180 minutes (HR 3.146, 95% CI 1.265-7.822, p = 0.014), and postoperative major complication (HR 3.778, 95% CI 1.205-11.847, p = 0.023), clinically significant POPF (HR 3.642, 95% CI 1.065-12.451, p = 0.039) were independent risk factors for POI after DP. Therefore, especially in patients with these risk factors.

Оценка спаечного процесса после травмы печени в хроническом опыте

Background. The issue of studying the reaction of a macroorganism to use of various local hemostatic agents is relevant. In particular, an important factor for use of a certain hemostatic agent in practical medicine is the low probability of formation of adhesions in the postoperative period after its implantation. Aim. Was to investigate the peculiarities of the course of adhesion process in the abdomen of laboratory animals after liver injury and stoppage of bleeding by local spongy hemostatic agents in an experiment. Materials and Methods. As materials, various samples of spongy hemostatic agents were used: Tachocomb®, Na-CMC + tranexamic acid, Na-CMC. The study was performed on male rabbits of the «Soviet chinchilla» breed (10 in each experimental group) in the operating unit of the laboratory of experimental surgery and oncology of the Research Institute of Experimental Medicine of KSMU. Surgical intervention was performed using a video-surgical complex, a liver wound was formed, and to stop bleeding, the studied samples of hemostatic sponges were used. Before surgery and on the 1st, 3rd, 7th, 15th, 30th day after surgery each animal was made the control dynamic laparoscopy, in which the evidence and spread of peritoneal adhesions were macroscopically evaluated. Results. In the group where Tachocomb® collagenous plate was used for arrest of bleeding, practically no statistically significant differences were found in comparison of the results of control dynamic laparoscopy (CDL) – on the 1st day after injury, there was no active bleeding and adhesions, on the 30th day a decrease in the area of growth of connective tissue structures was noted in the region of injury, and the color of parenchyma was comparable with that of intact areas. The parameters were analyzed both within the group (at different periods of the experiment) and between the experimental groups. Conclusions. In the intra-group comparison, a small number of significant differences were noted which may evidence comparability of the adhesive process at different periods of the experiment in the study groups. In practically of all cases of adhesion, they attached to the anterior abdominal wall at the point of insertion of the cannula for laparoscope (or quite close to it) that may be associated with frequent trauma of the peritoneum in this region provided by the design of the experiment, and in all cases threadlike adhesions were found, the morphological substrate of which was a strand of greater omentum. There were no clinical manifestations of adhesive intestinal obstruction in laboratory animals.

FACTORS AFFECTING THE EFFECTIVENESS OF CONSERVATIVE MANAGEMENT OF APPENDICULAR MASS

INTRODUCTION/ PURPOSE Acute appendicitis is the most common surgical emergency in children. Appendicular mass is a relatively common complication in improperly treated patients. The management of appendicular mass remains controversial. This study aims at determining factors affecting the effectiveness of conservative management of appendicular mass. PATIENTS AND METHOD This was a retrospective study of 71 children younger than 15 years with appendicular mass who managed at Basra Children's Specialty Hospital during the period between 2015 and 2019. Factors like age of the patient, duration of symptom prior to hospital admission, size of the mass, complications, hospital stay and outcome are reviewed. RESULTS Appendicular mass complicates 3.9% of all cases of acute appendicitis. Conservative management of appendicular mass was effective in 84.5%. Appendicular mass occurred most frequently in children aged 5-10 year (48%). Male is more frequently affected than female with a ratio of 1.4. Regarding age effect on the efficacy of conservative management of appendicular mass, there is a significant association with P-value = 0.017. Duration of symptoms or size of the mass has no significant association with the success of conservative management. No mortality or major surgical complications are encountered. Although effective, conservative management prolong the length of hospital stay. CONCLUSION I concluded that conservative management of appendicular mass in children should be revised particularly in children younger than 5 years old, wherein operative treatment may be the first option. The reasons for that are high rate of failure of conservative management with early progress to appendicular abscess. These could be explained by the underdevelopment of greater omentum and so lacking of its protective effect in limiting the spread of inflammation. In addition, early appendectomy has the advantage of decreased risk of adhesive intestinal obstruction, shortening of hospital stay (so that less economic burden), and avoidance of second readmission for interval appendectomy.

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.

NEW PROSPECTS OF DIAGNOSIS IN EMERGENCY ABDOMINAL SURGERY

Summary. Aim. Search for new methods for diagnosing acute surgical pathology of the abdominal cavity (ASPAC).
 Materials and methods. 39 patients: liver abscess — 4, acute appendicitis, periapendicular abscess — 3, acute appendicitis, perito-nitis — 5, acute phlegmonous appendicitis — 7, acute phlegmonous cholecystitis — 4, colon perforation, peritonitis — 3 , acute uncomplicated adhesive intestinal obstruction — 4, uncomplicated peptic ulcer — 4. Measured the optical density of venous blood plasma on a spectrophotometer SF-4A. The control was given to 8 patients (adhesive intestinal obstruction, uncomplicated peptic ulcer disease).
 Results and discussion. A number of maxima of the values of the optical density of the plasma at wavelengths λ = 3.1, 3.5, 4.3, 6.1, 6.7, 9, 17.5 micrometers were revealed. Indicators differed depending on the type of underlying disease and complications. For analysis and comparison, patients were divided into groups: abscesses, peritonitis, destructive pathology without peritonitis (appendicitis, cholecystitis) and control. At wavelengths λ = 3.1, 6.1, 6.7, 9, 17.5 micrometers, the optical density in patients with no destructive pathology is significantly lower than in patients with such pathology. In addition, the indicators differ in the presence of peritonitis, abscesses and uncomplicated destructive pathology.
 Conclusions. In the presence of acute surgical diseases of the abdominal cavity in patients, the specific maxima of the optical density of venous blood plasma in the infrared region at wavelengths λ = 3.1, 3.5, 4.3, 6.1, 6.7, 9, 17 , 5 micrometers. Changes in the parameters of optical density differ, depending on the characteristics of the underlying disease and complications and have common patterns in the perforation of hollow organs, abscesses, peritonitis, destructive uncomplicated diseases. Determination of optical density is a promising area for improving the diagnosis of ASPAC.

Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals. Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance. Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%). Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.

Migration of a gastric bezoar to esophagus: A rare cause of acute dysphagia

Sudden onset of dysphagia due to a gastric bezoar migrating to the esophagus is a relatively rare condition. A 72-year-old male patient with known gastric bezoar presented with sudden difficulty swallowing following nausea and vomiting caused by adhesive ileus. Gastroscopic examination showed a bezoar and associated compression ulcers in the esophagus. The bezoar was pushed towards the stomach and extracted by successful endoscopic fragmentation.

Choledochal cysts – state of the art

Introduction. Choledochal cyst is enlargement of the external bile duct system that can lead to liver dysfunction and biliary cirrhosis in childhood and malignant degeneration of the liver and bile ducts in adulthood. There are many theories explaining the origin of the common bile duct cyst. However, none of them can explain the formation of all five different types. Most of them are congenital. However, some of them may be aquired. The theory of a long common biliopancreatic canal has become widespread and is still used to explain the formation of this type of cystic anomalies. If the common canal is long and its part is not surrounded by the sphincter of Oddi, the secret of the pancreas begins to be thrown into the choledochus. Proteolytic enzymes from the pancreas are quite active and can damage the epithelium and the wall of the bile ducts, which leads to their weakness and, as a result, dilatation of the choledochus. Ultrasound examination is the initial and main method for diagnosing choledochal cysts. In some cases, there is a need for endoscopic or magnetic resonance retrograde cholangiopancreatography, intraoperative cholangiography. Removal of the cyst and anastomosis of the common hepatic duct with the lumen of the jejunum or duodenum, performed through the subcostal approach, are standard procedures for the treatment of patients with a choledochal cyst. The advent of laparoscopy and the accumulation of experience in performing complex surgical interventions introduced a minimally invasive approach for the production of laparoscopic biliodigestive anastomoses. Intra- and postoperative complications include damage to the structures of the hepatic hilum, torsion of the abduction loop, incompetence and stricture of biliodigestive anastomosis, cholangitis, stone formation, adhesive intestinal obstruction, and malignancy of the cyst remnants.Conclusion. This literature review has demonstrated modern views on the origin, etiology, diagnosis and treatment of choledochal cysts. The scientific work discussed the versatile technical aspects of the surgical treatment of choledochal cysts in children and assessed its safety and effectiveness.

Спайкова кишкова непрохідність як ускладнення дивертикула Меккеля в дітей

Meckel’s diverticulum (DM) is a formation of the ileum caused by incomplete obliteration of the omphalomesenteric duct in the developing embryo. This is one of the most common anomalies of the digestive tract in children. Most DM develops completely asymptomatically. Clinical symptoms develop in only 16% of cases, and 50–60% of them are children under 10 years, an average of 2.5 years of age. The severity of clinical symptoms in DM is associated with the development of complications: intestinal bleeding, intestinal obstruction (intussusception, strangulation intestinal obstruction), diverticulitis with perforation and peritonitis, etc. The article presents a clinical case of adhesive intestinal obstruction in an 8-year-old, which occurred after DM in the anamnesis. As the adhesive intestinal obstruction is an extremely rare complication of DM in children, the presence of patients with acute surgical pathology of the abdominal cavity requires pediatric surgeons to clearly understand the occurrence of such complications in the perspective of the development of intestinal tube defect – DM and the need for the immediate radical treatment tactics in the event of this problem. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, Meckel’s diverticulum, complications, adhesive intestinal obstruction.

Clinical study of adhesion obstruction at a tertiary care hospital: a prospective observational study

Background: Adhesion obstruction is one of the most common presentations of acute abdomen and an important cause of general surgical consultation. This study aimed to analyse demographic features, clinical features, predisposing factors, and management of this surgical problem.Methods: The present study was a prospective observational study and was conducted in the Department of General Surgery of SMHS hospital entitling 267 patients who were diagnosed and treated over 5 years from May 2014 to April 2019.Results: The most common age group diagnosed with acute intestinal obstruction was between 31 to 40 years, with the incidence more in males (65.5%) as compared to females (34.4%). The most common clinical feature was abdominal pain (98.1%) followed by vomiting (93.6%), constipation (86.1%) abdominal distension (82.3%). Postoperative adhesions (40.07%) followed by obstructed hernias (23.3%) and malignancies (14.6%) were the most common predisposing factors. Ischemia was the most common complication in 11.2% of patients followed by necrosis at 6.7% and perforation at 2.9%. Adhesiolysis was the most common surgical procedure performed 43.8% followed by anatomical repair 21.7% and resection and end to end anastomosis 15.3%, enterotomy 10.86%, and Hartman’s procedure 8.2%.Conclusions: Adhesive intestinal obstruction is an important surgical emergency. Post-operative adhesions remain the most common cause of acute intestinal obstruction, with patients most commonly presenting with pain abdomen, all necessary steps must be taken to lessen the chances of adhesions after any surgical procedure.

CAUSES OF EARLY RELAPAROTOMIES IN SURGERY

Summary. Introduction. Despite the introduction of modern methods of diagnosis, tactics, and treatment of diseases of the abdominal organs, the risk of developing early postoperative complications remains high.
 The aim of this study is to clarify the causes of early postoperative complications and indications for their surgical treatment.
 Materials and methods. 3947 case histories of patients operated on for urgent indications were analyzed. In 73 cases, relaparotomies were performed in the early postoperative period (1.85 %).
 Results and discussion. The main nosologic unit, during the surgical treatment of which relaparotomies were performed, was acute appendicitis. Then there was a perforated pyloroduodenal ulcer and a strangulated hernia of various localization. The main indications for relaparotomy were progressive peritonitis, early adhesive intestinal obstruction, intra-abdominal abscesses, and infiltrates. In two cases, no pathology was detected during relaparotomy – there was an over diagnosis of postoperative peritonitis and anastomotic suture failure.
 Conclusion. 1. The main cause for relaparotomies in urgent surgery is the progression of preoperative peritonitis. 2. The second important cause is early postoperative adhesive intestinal obstruction. 3. Errors in intraoperative diagnostics, tactics, and techniques are the third leading cause of early relaparotomies.

Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

Prediction and prevention of postoperative intra-abdominal adhesive complications in children

The aim of this work was to study the morphology of adhesion formation under the influence of ozone in the experiment, as well as the development of prediction criteria and methods for correcting increased adhesion in children.Materials and methods. Experimental studies were carried out on 36 rabbits «Shinshilla» with a body weight of 0.7–1.2 kg., of which 12 animals were included in the control group, which did not carry out ozonation of the abdominal cavity. The main group consisted of 24 rabbits, which were divided into two subgroups (12 animals in each subgroup), which ozonized the abdominal cavity with an ozone-oxygen mixture. In order to study the prognostic value of the acetylation phenotype in the formation of intraperitoneal adhesions, 67 children with symptoms of adhesive intestinal obstruction were examined.Results. The results of experimental studies showed that in animals of the control group there was the formation of massive adhesions. The basis of adhesions is connective tissue with a significant number of fibroblasts, blood vessels and collagen fibers. In animals of the main group, sharp inhibition of adhesion formation, a delay in the differentiation of fibroblasts and inhibition of their synthetic function were revealed. Acetylation phenotype was determined in 58 patients with appendicular peritonitis. 30 (51%) children turned out to be slow acetylators, and in 28 (49%) patients the phenotype of fast acetylation was established. The results of the study allowed us to isolate fast acetylators as a risk group for excessive adhesion formation and timely start therapeutic and preventive measures.

TREATMENT OF ACUTE ADHESIVE INTESTINAL OBSTRUCTION WITH MINI-INVASIVE METHODS

The authors studied the results of treatment of patients with adhesive disease of the abdominal cavity, determined the frequency of relapses of adhesive intestinal obstruction and studied the possibility of laparoscopic adhesiolysis in the surgical treatment of acute adhesive intestinal obstruction. A total of 987 patients with AIN were operated on: of whichlaparotomy adheziolysis - 539, intestinal resection laparotomy with interintestinal anastomosis-246, intestinal resection laparotomy with excretion of intestinal fistula-88, laparoscopy adhesiolysis-114. The use of laparoscopic adhesiolysispromotes to the early restoration of intestinal motility within 24-48 hours, reduces the frequency of relapses of adhesive disease, and reduces the length of hospitalization on average to 6.8 days.