Postoperative Adhesive Bowel Obstruction Research Articles

Establishment of a postoperative bowel adhesion model in Rats

Postoperative adhesive bowel obstruction is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive bowel obstruction can be managed non-operatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive bowel obstruction. Treatment recommendations are still controversial. Intestinal adhesions commonly occur in patients after abdominal surgery, often between intestines, between intestines and the abdominal wall, or within the peritoneum. Adhesions can lead to symptoms such as abdominal pain, constipation, and bloating, and may result in serious complications such as intestinal obstruction, bowel necrosis, acute peritonitis, and sepsis, which can be life-threatening. Therefore, reducing the occurrence of intestinal adhesions is crucial for abdominal surgery. To minimize adhesions, endoscopic techniques can be employed to reduce the abdominal opening area and thus decrease the probability of adhesion formation. However, this approach requires specialized equipment and surgical skills, making it somewhat challenging. Alternatively, anti-adhesion products can be used to lower the risk of adhesion formation. In this study, a murine cecal abrasion adhesion model was established and will be simulated common adhesion scenarios observed in patients after abdominal surgery. The efficacy of anti-adhesion gel materials will be then evaluated to assess their anti-adhesion properties. The record of gross adhesion severity assessment was performed. The adhesion status between the cecum and abdominal wall was observed on postoperative days 3 and 14. The results was shown that three days post-surgery operation, the group exhibited more severe adhesions upon gross examination. By day 14 post-surgery operation (at animal sacrifice), the histopathological analysis revealed that the group exhibited thicker fibrous tissue thickness, increased neovascularization, and higher collagen accumulation in the peritoneum. Therefore, based on the results of this experiment, a postoperative bowel adhesion rat is reliable and can be safely used to test the efficacy of novel anti-adhesive formulations to prevent intra-abdominal adhesions by using this model.

PATTERN, MANAGEMENT AND OUTCOME OF ACUTE INTESTINAL OBSTRUCTION AT CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL

Background: Acute intestinal obstruction is one of the commonly encountered emergencies in surgical practice. Gynecological surgery, especially adnexal surgery and hysterectomy has a higher incidence of bowel obstruction as compared to bowel surgery. Conservative management can be done in patients with post-operative adhesive bowel obstruction if there is no evidence of ischemia, bowel necrosis, or perforation. Therefore, a correct diagnosis is essential for appropriate management. We conducted a study to evaluate the etiology, clinical presentation as well as management and outcome of patients presenting with Acute intestinal obstruction at our center. Methods: This was a retrospective study of all the patients with a diagnosis of Acute intestinal obstruction from January 2015 to December 2019. The diagnosis of Acute intestinal obstruction was made by a combination of clinical and radiological parameters. The data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16. The data were expressed in number and percentage. Results: During the study period, 178 patients were admitted with the diagnosis of Acute intestinal obstruction. Abdominal pain and vomiting were the main complaints seen in 98.3% (n=175) and 84.8% (n=151) respectively. Hernia (n=49, 27.5%) was the most common cause of acute intestinal obstruction in adults, and Intussusception (n=15, 8.4%) was the leading cause of Acute intestinal obstruction in a pediatric age group. Majority of the patients’ needs (n=148,83.1%) operative intervention to relieve the obstruction. The overall mortality rate was 6.7% (n=12). Conclusions: Hernia was the most common cause of Acute intestinal obstruction in adults while intussusception was the commonest in the pediatric age group.

Advances in clinical application of obstruction catheter in prevention and treatment of intestinal obstruction

Intestinal obstruction is one of the most common diseases in abdominal surgery, and its prevention and treatment is a clinical difficulty. Although surgical operation can solve the symptoms of obstruction, there are many postoperative complications, and it is easy to develop re-obstruction due to postoperative abdominal adhesion. The internal fixation of small intestine with obstruction catheter provides a new idea for the prevention of postoperative adhesive bowel obstruction. The use of transanal ileus catheter provides the possibility of direct intestinal anastomosis after resection of malignant obstruction in the left hemicolon and can reduce the incidence of postoperative complications. However, sufficient attention should be paid to the related complications, and prevention and treatment should be planned. It is important to note that the use of obstruction catheter is only one of the conservative treatments for bowel obstruction, and it is not a complete replacement of surgery. Surgical treatment should still be considered, if the catheter fails to significantly move, if the obstructive symptoms do not significantly improve 5 days after catheterization.

Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis.

Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction. From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction. Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6years, overweight and obesity, duration of symptoms ≥ 36h, C-reactive protein ≥ 99mg/L, duration of operation ≥ 60min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913-0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9. Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.

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.

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.

A Case of Post-Operative Adhesive Bowel Obstruction with Septic Shock Due to BacterialTranslocation of Klebsiella oxytoca

A Case of Post-Operative Adhesive Bowel Obstruction with Septic Shock Due to BacterialTranslocation of Klebsiella oxytoca

10 Years of Experience with Laparoscopic-Assisted Endorectal Soave Pull-Through Procedure for Hirschsprung's Disease in China

To report early and late results of laparoscopic-assisted endorectal Soave pull-through (LAEPT) with a short and V-shaped partial resection muscular cuff for Hirschsprung's disease (HD) over a 10-year period. The clinical courses of 218 patients who underwent modified LAEPT for HD were reviewed. LAEPT was described by the Georgeson technique. The main modifications included less dissection of the bottom of the pelvis, rectal mucosa dissection with a long cuff, coloanal anastomosis with a short cuff, and a V-shaped partial resection in the posterior wall of the muscular cuff. From September 1999 to July 2009, 218 patients were operated on by the same surgeon. Ages ranged from 15 days to 12 years old. The aganglionic segment was located in the rectum or sigmoid colon in 176 patients, in the left colon in 38 children, and in the transverse colon in 4 patients. The median operating time was 176 minutes. Conversion to open surgery was required in 2 patients. Bleeding of the left iliac vein occurred in 1 patient, and a 180° twist of the neorectum occurred in 2 cases. Median first bowel movement time was 23 hours, and median postoperative hospital stay was 10.4 days. Median daily defecation frequency was 4.6 within 2 weeks and 2.3 at 3 months postoperatively. The immediate postoperative complications included intestine herniation from the trocar site in 2 patients, perianal excoriation in 32 patients, and anastomotic leakage in 3 patients. Follow-up ranging from 6 to 120 months was obtained for 182 patients. Late postoperative complications included postoperative adhesive bowel obstruction (1.1%), enterocolitis (7.7%), anasomostic stenosis (2.2%), constipation (1.6%), and soiling (3.6%). Eighty-seven percent had excellent and good bowel function. LAEPT with a short muscular cuff with a V-shaped partial resection in the posterior wall is a safe and effective procedure for HD.