Development Of Intra-abdominal Complications Research Articles

SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: INDICATIONS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY. PRELIMINARY DATA FROM A RETROSPECTIVE STUDY

Acute small bowel obstruction (ASBO) continues to be one of the most difficult problems of emergency abdominal surgery.
 Materials and methods. The results of treatment of 123 patients aged 18–80 years with ASBO were evaluated. Patients were divided into two groups: 1st - with a positive result (survivors, n = 101), 2nd — with an unfavourable result (non-survivors, n = 22).
 Results. All these patients underwent emergency surgery: the adhesive disease was the main cause in 101 (82.1 %) patients with ASBO, small bowel obstruction in gallstones was in 2 (1.6 %) and volvulus was the cause in 20 (16.3 %) ) patients. Small bowel ischemia developed in 49 (39.8 %) patients: reversible in 21 (42.9 %) and irreversible in 28 (57.1 %) patients; generalized peritonitis was present in 24 (19.5 %) patients, in 18 (75 %) of them abdominal sepsis was presented according to the criteria of Sepsis-3. After the operation, 22 patients (17.9 %) died, which were analyzed: in the early stages (first 72 hours), seventeen patients (77.3 %) and others (22.7 %) - from the third to the seventh day of the postoperative period. Studies have shown that only three laboratory parameters (blood leukocytes, lactate and C-reactive protein) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with a probability of 80 % or more were significantly associated with strangulated ASBO, as well as six indicators with the same probability were associated with early mortality after surgery. In both groups, the main operation in 95 (77.2 %) patients was adhesiolysis, transnasal tube of the small intestine and drainage of the abdominal cavity. The choice of access for surgery (laparoscopy or laparotomy) (P = 0.000), as well as the duration of surgery (P = 0.038), affected the results of the treatment in patients under analysis, although the types of operations performed did not significantly affect the results in these groups patients (P = 1.000). Immediate results in patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early re-operation (P = 0.006). The development of postoperative complications, such as cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000), also affected the treatment outcomes in these patients.
 Conclusion. It was confirmed that three laboratories and one instrumental parameter were indicated of strangulated ASBO before surgery and the six parameters studied were predictors of early mortality before surgery with a probability of 80 % or more.

SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: CLINICAL AND LABORATORY PARAMETERS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY

The aim: The study aimed to evaluate some criteria for preoperative diagnosis of strangulation and significant indicators of the prognosis of short-term outcomes in patients with small bowel obstruction. Materials and methods: The results of the treatment of 123 patients aged 18-70 years with SBO were evaluated. Results: All of these patients underwent emergency surgery, and 22 patients (17.9%) have died. It has been shown that four lab parameters (blood leukocytes, lactate, intestinal fatty acid-binding protein, and C-reactive protein levels) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with 80% probability or more were associated with the strangulation type of SBO (Λ=0.276, p = 0.000). Three lab indicators (WBC count, serum lactate, and intestinal fatty acid-binding protein levels) and two clinical parameters (abdominal perfusion pressure level and the presence of abdominal sepsis) were associated with early mortality after surgery (Λ=0.626, p = 0.000) with the same probability. Immediate results of the treatment in these patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early reoperation (P = 0.006) as well as the development of cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000). Conclusions: There were confirmed parameters that were significantly associated with strangulation before surgery and short-term in-hospital mortality with an 80% probability or more. This made it possible to develop new mathematical models for the diagnosis of strangulated bowel obstruction and early postoperative mortality with an accuracy of 84.5% and 84.2%, respectively.

RELAPAROTOMY IN THE TREATMENT OF INTRA-ABDOMINAL COMPLICATIONS OF ABDOMINAL SURGERY

Summary. Relaparotomy in the treatment of postoperative complications of abdominal surgery remains a complex problem in modern surgery.
 Purpose: to study the causes of relaparotomy after surgical operations on the abdominal organs, depending on the nature of the first surgical intervention.
 Material and Methods: A retrospective analysis of the performance of 74 relaparotomies after surgical treatment of abdominal pathology was performed. The first surgical intervention was performed because of acute cholecystitis (11 patients), choledocholithiasis (4), acute destructive appendicitis (8), perforated stomach or duodenal ulcers (8), strangulated hernia (5), adhesive intestinal obstruction (9), perforation of thin or colon (7), obstruction of the colon of tumor origin (19). Indications for relaparotomy were peritonitis, early adhesive intestinal obstruction, intraperitoneal bleeding.
 Conclusions: Complications associated with intra-abdominal infection — peritonitis, peritonitis due to insolvency of anastomotic sutures, is the most common cause of relaparotomy after operations on the abdominal organs, requires improvement of both technology of operations and antibacterial therapy. Relaparotomy is a life-saving surgery in the development of intra-abdominal complications, but it is associated with a greater risk of mortality.

Pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications in refractory peritoneal dialysis-related peritonitis.

Some patients with refractory peritoneal dialysis-related peritonitis continue to develop intra-abdominal complications despite removal of the peritoneal catheter. Repeated percutaneous drainage or open laparotomy is often required, and mortality is not uncommon. The benefits of pelvic drainage placement during catheter removal in decreasing these complications and interventions remain unproven. Forty-six patients with refractory peritonitis who underwent removal of a Tenckhoff catheter between 1991 and 2013 were reviewed retrospectively. Twelve patients had pelvic drainage using closed active suction devices during catheter removal (drainage group). The remaining 34 patients underwent catheter removal without drainage (non-drainage group). The outcomes measured were the development of intra-abdominal complications and the requirement for repeated percutaneous drainage or open laparotomy within 90 days after the catheter removal. Baseline characteristics were similar with the exception of a higher median number of previous peritonitis episodes in the drainage group compared with the non-drainage group (2 vs 0, P = 0.02). During the follow-up period, intra-abdominal complications occurred in 15 (44%) of 34 patients in the non-drainage group, compared with one (8%) of 12 patients in the drainage group (P = 0.03). Twelve (35%) patients in the non-drainage group required repeated percutaneous drainage or open laparotomy for management, compared with zero (0%) patients in the drainage group (P = 0.02). Drain tubes were removed at a median of 6 days (inter-quartile range: 5-10) without complications. In the management of refractory peritonitis, pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications and invasive interventions.