Adhesive Obstruction Research Articles

ACUTE ADHESIVE OBSTRUCTION OF THE SMALL INTESTINE: PREVENTION, TREATMENT

ACUTE ADHESIVE OBSTRUCTION OF THE SMALL INTESTINE: PREVENTION, TREATMENT

A clinical study of gastrointestinal obstruction among children in a tertiary referral centre of North India

Background: Children are a unique lot in that, since, in contrast to adults, in which post op adhesive obstruction and inflammatory causes predominate, in children congenital causes also make a significant part.Methods: This study was a retrospective analysis of the clinico pathological data of patients (between 1 month and 12 years of age) who presented to the department of surgery, MLNMC, Prayagraj with clinical diagnosis of intestinal obstruction. The study included patients who were admitted to the department between April 2013 and April 2019.Results: A total of 130 patients were admitted in pediatric unit of general surgery department during the study period. Of these 83 were males and 47 were females. In the end, 116 fulfilled the inclusion or exclusion criteria. 21 patients were successfully managed conservatively. 95 were operated.Conclusions: Intussusception is the most common cause. Kochs abdomen is the most common cause in children >5years with a vast majority being females. Majority of the patients whose clinical diagnosis is Koch’s abdomen, post-operative adhesive obstruction or worm infestation can be conservatively managed. Obstructed inguinal hernia still remains a potential preventable cause of intestinal obstruction.

Current Spectrum of Intestinal Obstruction in a Teaching Hospital

Intestinal Obstruction is a common surgical emergency and constitutes a major cause of morbidity and financial expenditure in hospitals around the world. This study aimed to provide the current spectrum of intestinal obstruction in a tertiary care hospital with a special view to identify any change in the aetiologic pattern. This prospective observational study was carried out in all four surgical units of Rajshahi Medical College Hospital from September 2010 to August 2011. The study included 250 adult patients with clinical and radiological evidence of complete intestinal obstruction. Out of 250 consecutive patients ranging between (13-90) years with a male to female ratio of 2.1:1, the maximum cases were within (31-40) years and (51-60) years of age group. In this study 175 cases (70%) were presented with small bowel and 75 cases (30%) with large bowel obstruction. The main causes of obstructions were bands and adhesions (44%) followed by volvulus (18%), external hernias (16%), neoplasm (12%), intussusceptions (3.2%), intestinal tuberculosis (2.8%) and miscellaneous (4%). Approximately, 86% patient with adhesive obstructions had previous laparotomy while 42% needed surgical exploration for failed conservative management. The overall mortality was 8%; mainly owing to strangulating obstruction and old age. Varying degrees of wound infections were the common post-operative complications. There was a significant change in the aetiologic pattern of intestinal obstruction. Post operative adhesions were the commonest cause of obstruction and appendicectomy was the most common previous operation causing adhesion.
 TAJ 2019; 32(1): 62-69

Surgical treatment for acute appendicitis in HIV/AIDS patients

Fifty three HIC/AIDS patients with acute appendicitis treated in our hospital from January 2016 to June 2017 were retrospectively analyzed. The anesthesia and surgery were successfully completed in all patients, and there were no serious intraoperative complications. The postoperative complications occurred in 18 cases (34.0%), including 13 cases (24.5%) of incision infections and 3 cases (5.7%) of lung infections, 1 case of adhesion obstruction (1.9%) and 1 case (1.9%) of new opportunistic infections. All patients were clinically cured after treatment and discharged from the hospital without perioperative death. The characteristics of acute appendicitis in HIV/AIDS patients are emergent onset, poor body condition, lower immunity, more comorbities, rapid condition changes, and high frequency of special infections; the patients with lower CD4 count may have higher postoperative infection, the slower recovery and the poorer outcomes. Key words: HIV infections; Acguired immunodeficiency syndrom; Appendectomy; Appendicitis

Laparoscopic Soave procedure for long-segment Hirschsprung's disease - single-center experience.

IntroductionHirschsprung’s disease (HD) is one of the most common and severe diseases treated in pediatric surgery. Since the introduction of the laparoscopic technique into pediatric surgery, laparoscopic-assisted radical surgery for HD has demonstrated unique advantages. Long-segment and total-colon HD are the best indications for laparoscopic-assisted surgery.AimTo summarize clinical experience of the laparoscopic Soave procedure for long-segment HD in a single center.Material and methodsThe data of children with long-segment HD who underwent the laparoscopic Soave procedure in our department from January 2013 to May 2018 were reviewed. The clinical features, surgical procedures and follow-up results were summarized and analyzed.ResultsThirty-one children underwent the laparoscopic Soave procedure; none of them were converted to open surgery. The average hospitalization time was 8.7 days after the operation, and no immediate postoperative complications occurred. There was no recurrence of constipation. Six (19.3%) cases were complicated with HD associated enterocolitis in the first 3 months postoperatively; 5 (16.1%) cases had soiling in the first year. There were 0 cases of adhesive bowel obstruction, 0 cases of anastomotic stenosis, and 0 cases of constipation.ConclusionsA small volume centre may achieve satisfactory results for long-segment HD. The laparoscopic Soave procedure is a minimally invasive, safe and effective treatment.

P2.26: Optimizing the Management of intestinal pseudo-obstruction with effective bowel decompression using a pan intestinal decompressive tube

Children with intestinal psuedoobstruction are notoriously hard to manage. Refractory abdominal distension, small bowel bacterial overgrowth, inability to feed, frequent line infections, septic episodes and intestinal failure related liver damage are unfortunate realities in the management of these children. It’s also hard to determine how contributory adhesive bowel obstruction is to the ongoing abdominal distension. One of the central factors contributing to all this is the inability to effectively decompress the inherently poorly peristaltic long tubular length of the intestine. We devised a simple solution to effectively decompress the entire length of small bowel by passing a perforated decompresive tube all along its length that went from the DJ flexure to the caecum. Low profile devices at both ends ensured decompression into bags at both ends. The resulting decompressed bowel with reduced luminal calibre prevented stasis and promoted some peristalsis. In, addition it stented the bowel in a non-obstructive pattern in the abdomen. 8 children with intestinal pseudo obstruction had pan intestinal decompressive tubes placed. Ages ranged from 5 weeks to 16 years. All children had improvement in their abdominal distension, were able to take oral feeds and started stooling more frequently. 2 children with gastroschisis came off TPN after 4 and 6 months. Serum bilirubin improved initally in all children. In 2 children, after temporary relief, there was progression to liver failure and eventual death. In 3 children, additional procedures to reduce leakage around the tubes and skin excoriation were done. In 7 children, this reduced hospitalization significantly and allowed management to continue from home. In children with intestinal psuedoobstruction, the placement of a pan intestinal decompressive tube can mitigate several of the problems associated with this condition. In gastroschisis with hypomotilitiy, it has the potential to restore motility and avoid the need for a transplant.

Etiologic Spectrum of Intestinal Obstruction in Ningxia District: A Retrospective Analysis of 4908 Cases in a 10-Year Period.

Background Economic disparity contributes to the variation of intestinal obstruction (IO) etiologic spectrum. Clarifying the etiology distribution in local regions can help to unravel IO and promote early diagnosis, henceforth making sure standardized therapeutic interventions. Methods Medical data of 4908 inpatients diagnosed with IO admitted to the General Hospital of Ningxia Medical University between January 2004 and December 2013 were recruited and analyzed retrospectively. The associated profiles included demographic features, clinical manifestations, and previous therapeutic operations. Results 4908 cases of intestinal obstruction were identified during the period of study. It denoted that the hospitalization rate of IO has maintained upward momentum; the top four causes of IO were adhesion, tumor, intussusception, and hernias. These covered up nearly 80% of the total constitution. Among them, adhesive intestinal obstruction accounted for 45.17%, malignant bowel obstruction for 21.09%, intussusception for 8.72%, and hernia for 4.73%; abdominal surgery constituted for the majority (78.62%) of adhesive obstruction. The followed up analysis also found that appendectomy accounted for the biggest percentage, 28% of operation cases. Malignant bowel obstruction can have a rate of 96.43% in 1035 cases led by tumor lesions. Of which, the primary intestinal malignant tumor accounted for 68.64% and metastatic tumors for 31.36%. Nearly 50% occurred in the large intestine. The overall mortality of all 4908 cases was 4.7%. Conclusion The hospitalizations of IO delineated an increasing trend. Adhesion was the main etiology in IO. The odds of malignant bowel obstruction was increasing in the proportion of IO. There were some differences towards the etiologic spectrum compared with western countries.

Surgical Techniques and Long-Term Outcomes of Flexible Neuroendoscopic Aqueductoplasty and Stenting in Infants with Obstructive Hydrocephalus: A Single-Center Study

To technically review and explore long-term follow-up results of aqueductoplasty and stenting under flexible neuroendoscopy in infantile obstructive hydrocephalus. The clinical data, surgical techniques, and long-term effects in 14 infants with obstructive hydrocephalus treated by flexible neuroendoscopic aqueductoplasty and stenting between 2008 and 2010 were analyzed retrospectively. The 14 infants had a mean age of 5.71 ± 3.10 months (range, 2-11 months) and a mean duration of follow-up of 62.64 ± 34.52 months (range, 9-121 months). Subdural effusion was observed in 4 infants (28.6%) after surgery. There were no deaths or serious complications related to intracranial stent placement. Three infants (21.4%) failed, 2 due to proximal aqueduct occlusion from a short stent length and 1 due to intraluminal ependymal adhesion obstruction. One case was abandoned when a second surgical adjustment stent was unsuccessful, and the other 2 cases went to shunt surgery. Aqueductoplasty with stenting is a feasible and safe surgical procedure for treating infants with midbrain aqueduct stenosis or occlusion. However, the optimal stent material and definitive outcomes after this procedure require additional long-term follow-up studies in large numbers of infants.

The auto-transplantation of uterus in swine: surgical techniques and long-term graft survival

Objective: Uterus transplantation (UTx) provides a available treatment for women with absolute uterus-related infertility. The aim of this study was to develop surgical techniques for UTx and to observe the long-term graft survival in the swines. Materials and Methods: Ten female swines received uterus auto-transplantation surgery after general anesthesia. The operative time, ischemic time, and vascular injury in each swine were recorded. The bicornual uterus with vaginal canal and main vessel were removed, bake-table preparation was performed with cooled at 4°C, and perfused with heparin saline with continuous flushing. The uterus was placed in original pelvic position. The uterus arteries and veins were end-side anastomosed with external iliac arteries and veins in the host swines. Results: One case was randomly selected as the preliminary experiment. The remaining nine cases showed that the uterine arteries and veins were anastomosed successfully and only eight cases attained long-term survival. The host in another case died four days after surgery from suspicious embolism postoperation. The blood flow of uterus arteries was observed by Doppler ultrasonography at four days after the operation and no congestion was found. The second-look laparotomy at six months after surgical was subsequently performed and the uterus showed a normal morphology and size. However, the pregnancy was unsuccessful due to the shorter observation time, and the severe adhesion and tubal obstruction after surgery may have affected pregnancy of those swines. Conclusion: These preliminary experiences suggest that the uterine auto-transplantation using the end-side vascular anastomosed method is feasible. The accumulation of basic data and experiences from swine experiments can provide important guidance for establishment of UTx in humans.

The role of laparoscopic adhesiolysis in the treatment of patients with recurrent, adhesive intestinal obstruction Menoufia Medical Journal

Objective The aim of this study was to assess the role of laparoscopic adhesiolysis in the treatment of patients with recurrent attacks of adhesive intestinal obstruction. Background Adhesive intestinal obstruction represents a common clinical problem following abdominal surgery with a high recurrence rate. Once adhesion has formed, its only means of elimination is operative adhesiolysis. Theoretically, adhesiolysis performed through a laparoscope is expected to provide better outcomes than the conventional open procedure. Patients and methods This is a prospective study that was done on a consecutive sample of 20 patients who were admitted to Menoufia University Hospital and Damanhour Medical National Institute during the period between April 2016 and February 2017 with recurrent postoperative adhesive intestinal obstruction that improved with conservative management. Exclusion criteria were peritonitis, severe abdominal distension, pregnancy, liver diseases, and previously confirmed or strongly suspected abdominal malignancy. All patients had undergone elective laparoscopic adhesiolysis after obtaining informed consent. Patients were followed up for 6 months. The complications and the outcome of the operation were recorded. Results Postoperative adhesions were identified laparoscopically in all patients. In the majority of cases (80%), the location of adhesions was distal to the lower abdomen. Successful complete laparoscopic adhesiolysis was feasible in 18 (90%) patients. Conversion to laparotomy was required for two (10%) patients because of intestinal perforation (n = 1) or a convoluted mass of adherent bowel (n = 1). One recurrence of intestinal obstruction was noted over a follow-up period of 6 months and improved with conservative management. Conclusion Laparoscopic adhesiolysis for recurrent postoperative adhesive bowel obstruction is feasible and safe, with a high success rate in experienced hands and results in minimal perioperative morbidity.

Therapeutic Role of Oral Water Soluble Contrast in Treatment of Early Adhesive Intestinal Obstruction in Pediatric Population

Introduction and objectives: Adhesive bowel obstruction is considered one of the commonest causes of intestinal obstruction managed in daily practice, medical schools differ in management plans from conservative to interventional measures with increased morbidity and mortality with recurrent surgical interventions, the aim of our study is to evaluate the therapeutic role of oral water soluble contrast (urographin) in treatment of early adhesive intestinal obstruction. Patients and methods: All pediatric patients presented at our units in the period from December 2016 to December 2017 by early adhesive intestinal obstruction were included in this study. All patients were given conservative treatment for 24 hours (nothing per mouth, insertion of nasogastric tube, and intravenous fluids). Patients with failure of improvement after 24 hours were divided to 2 groups in the first group we continued the same conservative measures for 48 hours, in the second group we used single oral dose of urographin. Follow up of the patients was done clinically and radiologically for another 48 hours. Demographic data, type of first surgery, results, complications, and outcome all were collected and statistically analyzed. Results: The study included 35 patients, oral urographin was used in 14 patients, and we continued traditional measures in 21 patients. The mean duration of hospital stay in the urographin group was 3.36 ± 0.49 while in the conservative group was 6.24 ± 0.89 with P value <0.001. Recurrence occurred in (14.3%) of cases in urographin group and in (33.3%) of cases in conservative group Conclusion: The period of hospital admission is significantly shorter with the use of oral water soluble contrast (urographin) with fewer incidences of recurrent attacks but it doesn’t decrease the incidence of shifting to surgery. The use of urographin is safe with no significant harmful side effects observed.

Etiology and Management of Small Bowel Obstruction with Special Reference to Role of Laparoscopy—A Single Centre Experience

Background: Small bowel obstruction (SBO) is the commonly diagnosed disease in the emergency department. The diagnosis and management of small bowel obstruction varies among institutions. The role of laparoscopy in the management of small bowel obstruction is debatable. Aim: To study the profile, clinical features and management options of patients of small bowel obstruction with special emphasis on role of laparoscopy. Material and Methods: 51 consecutive patients with documented small bowel obstruction admitted in our department were studied from June 2016 to December 2018. All the patients above 12 years of age with small bowel obstruction were included. The diagnosis of small bowel obstruction (SBO) was made in these cases by detailed history, clinical examination and investigations. All these patients were received and adequately resuscitated. Non-operative (conservative) treatment was confirmed to those who met the standard parameters for such treatment and early surgical treatment was carried out whenever indicated. The operative procedure done was laparoscopy or open depending on the clinical features and condition of patient. Results: In our study, 51 patients mean age was 44.7 years with 27 Males and 24 females. 28 (54.9%) patients of our study presented with continuous abdominal pain followed by colicky pain in 23 (45.1%) patients. 34 (66.7%) patients on admission gave history of effortless vomiting. Distension of abdomen was present in 30 (58.8%) patients and constipation was present in 40 (78.4%) of our studied patients. On CT scan interloop fluid was present in 23 (45.1%) patients while transition point was present in 31 (60.8%) patients. Adhesion obstruction was found to be most common cause of obstruction 27 (52.9%) patients, followed by malignancy in 8 (15.7). 25 (49.0%) patients were managed conservatively and 26 (51%) were operated. 11 (21.6%) patients underwent laparoscopic adhesiolysis and 15 (29.4%) underwent exploratory laparotomy. The average operative time, recovery of bowel moments, hospital stay, and post-operative complications were less in the laparoscopic group than open group with statically significant difference between the two. Conclusion: Post-operative adhesion obstruction is the most common cause of small bowel obstruction. Laparoscopy is a safe and effective tool for the management of acute intestinal obstruction provided it is performed in selected patients by skilled surgeon.

Paediatric Abdominal Surgical Emergencies in Enugu, South East Nigeria: Any Change in Pattern and Outcome

Background: Paediatric abdominal surgical emergencies (PASE) constitute a significant workload of the paediatric surgeon. The objective of this study was to characterize the pattern of PASE in a tertiary hospital in Enugu and determine any change in pattern and outcome. Methodology: This was a retrospective study of children aged 1 day to 16 years who presented with abdominal surgical emergencies to Enugu State University Teaching Hospital (ESUTH), Enugu. Result: There were 152 patients recruited for the study. There were 122 males and 30 females. The mean age at presentation was 6 years while the mean duration of symptoms before presentation to the hospital was 3.5 days. Thirty eight (25%) patients presented within 48 hours of the onset of their symptoms while 114 patients (75%) presented after 48 hours. The emergencies were intussusception 56 (36.8%), typhoid intestinal perforation 30 (19.7%), obstructed hernia 20 (13.2%), appendicitis 17 (11.2%), abdominal trauma 10 (6.6%), neonatal intestinal obstruction 6 (4%), ruptured appendix 6 (3.9%), Hirschsprung’s disease 4 (2.6%), adhesive bowel obstruction 2 (1.3%), and Gastroschisis 1 (0.7%). The mean hospital stay was 6.7 days. Thirty four patients (22.4%) who had surgery developed post-operative complication. The most common complication was surgical site infection and this occurred most in patients who had typhoid intestinal perforation (P = 0.017). There were 12 (7.9%) deaths. Conclusion: In this series, intussusception was the most common paediatric abdominal surgical emergency seen in Enugu unlike in the past when it used to be typhoid intestinal perforation. Mortality was less in the current study. This illustrates a change in pattern and outcome.

Postoperative intestinal intussusception in children, an easily missed culprit of postoperative intestinal obstruction: Case series and literature review

BackgroundPostoperative intestinal intussusception (POI) is a rare cause of intestinal obstruction with POI after surgical reduction of ileocolic intussusception being an extremely rare variant. POI was reported to follow many abdominal and non-abdominal operations. A late diagnosis can risk ischemia and necrosis. POI also increases the morbidity and mortality, rendering an early diagnosis and prompt management as lifesaving. MethodsWe reviewed the medical charts retrospectively for the last ten years for patients with POI at Palestine Red Crescent Society Hospital, Hebron, Palestine. We reviewed the literature and presented the characteristics of the most reported cases of POI following surgical reduction of ileocolic intussusception. ResultsWe presented three cases of ileoileal POI and one case of ileocolic POI followed different primary operations. All but one patient presented in the first two weeks. The delayed presentation came two months after revision of a prolapsed colostomy. All patients managed successfully with operative manual reduction with no postoperative complications. Initially, we had struggles in the diagnosis of POI largely due to a low suspicion for this rare entity, but thereafter we kept POI in mind and managed the after-coming cases in an expeditious manner. ConclusionFrequently, POI is misdiagnosed as postoperative adhesive obstruction. POI is challenging in diagnosis and needs a very high index of suspicion, mainly due to its rarity and atypical presentation. By keeping the possibility of POI in mind, one can easily diagnose it and prevent its consequences.

MORPHOLOGICAL CHANGES OF THE SMALL INTESTINE IN ACUTE STRANGULATIVE INTESTINAL OBSTRUCTION IN THE STAGE OF DECOMPOSITION IN CHILDREN

Purpose. The purpose was to determine the depth and prevalence of pathomorphological changes in the small intestine of children at the distance from the visible border of necrosis with decompensated acute strangulated intestinal obstruction (ASIO) to determine the minimum possible length of intestinal resection.Material and methods. Morphological studies of a resected fragment of the small intestine were performed in 24 children aged 3 days to 18 years who had undergone a surgery for ASIO with intestinal necrosis. Strangulated adhesive obstruction was found in 17 children, five children had congenital intestine torsion and two children faced small intestinal strangulation in the congenital mesenteric defect. The postsurgical material was studied morphologically using histological stains with the distance of 3 cm between the section.Results. The depth, prevalence of the morphological changes in the small intestinal wall, intensity and length of morphological changes in children with decompensated ASIO were determined.Conclusion. A differentiated approach to the selection of resection scope in the proximal and distal directions from the visible border of ASIO-related necrosis is necessary. The distances are twice shorter in children as compared to adults. Refusal from extensive resections will enable to reduce the rate of short bowel syndrome in children.

Risk of adhesive bowel obstruction after abdominal surgery. A national cohort study of 665,423 Danish women

BackgroundAdhesive bowel obstruction is associated with considerable morbidity and mortality, but the magnitude of the risk is debated. MethodIn a national cohort of all Danish women with an abdominal operation (N = 665,423) between 1977 and 2013, the risk of adhesive bowel obstruction was assessed by Cox multiple regression. Covariates were the number of abdominal operations, the surgical methods, the anatomical site involved, and the calendar year. ResultsIn the cohort, 1.4% experienced an episode of adhesive bowel obstruction. The risk increased 33–43% during the study period, was lower after gynecological and obstetrical procedures compared to gastrointestinal (HR 0.36 [0.34–0.38]), lower after laparoscopic compared to laparotomic surgery (HR 0.51 [0.48–0.54]) and increased proportionally after each additional operation. ConclusionsThe risk of adhesive bowel obstruction after abdominal operations depends on the site of earlier operations, the method of access and the number of earlier operations.

Optimal time for single-stage pull-through colectomy in infants with short-segment Hirschsprung disease.

Short-segment Hirschsprung disease (HSCR) is the predominant type of HSCR that affects approximately 75% of patients. Whether single-stage endorectal pull-through (ERPT) surgery is appropriate for neonatal patients with HSCR has not been definitively determined. This retrospective cohort study concerning infants with short-segment HSCR investigated the optimal age for single-stage ERPT surgery, regardless of the operative approach. The 198 patients were stratified by operative age ≤ 3 or > 3months (groups A or B, respectively, n = 62 and 136, respectively). Diagnoses of short-segment HSCR were conducted by preoperative contrast enema and rectal suction biopsy with acetylcholinesterase immunohistochemical staining. The perioperative clinical course for all patients was reviewed and the accuracy rate of the preoperative diagnoses and postoperative short- and midterm outcomes were assessed. The rates of diagnostic accuracy, according to the results of the preoperative contrast enema or rectal suction biopsy, were lower in group A (67.2 and 93.5%, respectively) than in group B (81.4 and 94.9%, respectively). In groups A and B, 49 (79.1%) and 108 (79.4%) infants, respectively, completed follow-up examinations. The short-term outcomes were postoperative HSCR-associated enterocolitis, adhesive bowel obstruction, anastomosis leakage, and anal stenosis during the first 12months after surgery. The midterm outcomes were incontinence and constipation at ~24months after surgery. Compared with group B, group A experienced more incidences of anastomotic leakage in the short-term and more soiling in the midterm. In groups A and B, the rates of constipation recurrence were nil and 1.9%, respectively. Infants with HSCR ≤3months old at the time of single-stage ERPT surgery showed lower rates of accurate and conclusive diagnostic results and poorer postoperative outcomes. Waiting to perform this surgery until infants are older might be more beneficial.

Intestinal malrotation in infants with omphalocele: A systematic review and meta-analysis

PurposeThe management of intestinal malrotation in infants with omphalocele varies among surgeons. Herein, we aimed to determine whether infants with omphalocele should be investigated for malrotation. MethodsUsing a defined search strategy, three investigators identified all studies reporting patients with omphalocele and malrotation. Outcome measures included: 1. incidence of malrotation; 2. correlation with the abdominal size defect in patients with omphalocele; 3. risk of volvulus in those not investigated for malrotation; 4. incidence of adhesive bowel obstruction in those who underwent Ladd's procedure. The meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. ResultsOf 111 articles analyzed, 12 (3888 children) reported malrotation in 136 patients (3.5%). Malrotation was equally found in patients with major (15.2%) and minor (13.6%; p = 0.52) omphalocele. A volvulus was more common in children who had Ladd's procedure (8%) than in those who did not (1%; p = 0.03). Adhesive bowel obstruction rate was similar in both groups (5% vs. 3%; p = 0.21). ConclusionThe incidence of malrotation in infants with omphalocele is low but probably underreported, and is not influenced by the size of the defect. At present, there is no evidence in the literature to support investigations to detect malrotation in infants with omphalocele. Type of studyTherapeutic. Level of evidenceIII

Effectiveness of hyaluronic acid/carboxymethylcellulose in preventing adhesive bowel obstruction after laparoscopic radical cystectomy

Adhesive bowel obstruction is one of the most frequent complications after radical cystectomy, prolonging hospital stay and fasting period and increasing medical expenses. This study evaluated the effectiveness of hyaluronic acid/carboxymethylcellulose (HA/CMC) in preventing adhesive bowel obstruction after laparoscopic radical cystectomy. Randomized, controlled, single-blinded study was performed. Of 76 patients who underwent laparoscopic radical cystectomy for bladder cancer, 38 received HA/CMC instillation and 38 did not. The primary endpoint was the rate of postoperative adhesive bowel obstruction. The secondary endpoint was the rate of other postoperative outcomes. None of the patients who received HA/CMC instillation experienced postoperative adhesive bowel obstructions, compared with six (15.79%) patients in the control group (p=0.025). Of the six patients with ileus, two underwent adhesiolysis. There were no significant differences between the two groups in other postoperative outcomes. HA/CMC instillation during laparoscopic radical cystectomy may reduce the incidence of postoperative adhesive bowel obstruction without adverse effects.

The Advantages of Minimally Invasive Surgery for Peritoneal Adhesions in Children

Background.Laparoscopic surgery has advantages over laparotomy. In pediatric practice, only single studies have been devoted to the leading role of laparoscopy in the treatment of peritoneal adhesions in children; randomized controlled studies have not been conducted.Objective.Our aim was to assess the advantages of laparoscopic methods of surgical treatment in patients with adhesive intestinal obstruction.Results.The main group included 58 children aged from 10 days to 18 years who underwent laparoscopic surgery. The control group included 49 children with acute adhesive intestinal obstruction. The incidence of early and late adhesive obstruction was 18 (31%) and 40 (69%) cases in the main group, 21 (42.9%) and 28 (57.1%) cases in the control group. The number of previous surgical interventions in the main group ranged from 1 to 6, in the control group – from 1 to 7. The advantages of a laparoscopic approach to the treatment of acute adhesive obstruction are confirmed by a significantly lower expression of the postoperative intestinal paresis and rapid recovery of peristalsis, early onset of enteral nutrition, and relatively rapid discharge from the hospital. It is important to note the absence of early and late postoperative complications in the laparoscopic group, especially repeated cases of intestinal obstruction (in contrast to the control group where two patients required repeated operations for obstruction).Conclusion.Laparoscopic technologies are a method of choice in the treatment of children with acute adhesive intestinal obstruction regardless of the age of patients, the extent of the adhesion process, the anatomical mechanism of intestinal obstruction.