Laparoscopy in the Treatment of Acute Small Bowel Obstruction

  • Authors: 1, 2, 3, 3, 2, 4
  • Affiliations:
    1. A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation Central Clinical Hospital, 2A Lenina Str., Reutov, 143964, Russian Federation
    2. A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation Federal Research and Clinical Center of Specialized Medical Care and Medical Technology of FMBA, 28 Orekhovyi Blvd, Moscow, 115628, Russian Federation
    3. Central Clinical Hospital, 2A Lenina Str., Reutov, 143964, Russian Federation
    4. A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation
  • Issue: Vol 7, No 3 (2014)
  • Pages: 228-236
  • Section: Original articles
  • URL: https://vestnik-surgery.com/journal/article/view/576
  • DOI: https://doi.org/10.18499/2070-478X-2014-7-3-228-236
  • ID: 576

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Full Text

Abstract

Patients with acute intestinal obstruction constitute about 6% of all patients with an acute surgical pathology, coming in surgical hospitals. Patients with adhesive small bowel obstruction are 50-50%, and with obstructive ileus (benign nature) 5-6% of the total number of patients with intestinal obstruction. Surgery for acute adhesive intestinal obstruction are accompanied by a significant number of postoperative complications, especially in the case of repeated operations on the occasion of obstruction. From June 2009 to December 2013 at the surgical clinic Reutov Central city clinical hospital made 34 operations for acute small bowel obstruction. In 30 cases, the cause obstruction were postoperative adhesions, in 4 cases, the obstruction was caused by phytobezoars. In 10 cases performed laparoscopically elimination of acute adhesive small bowel obstruction, in 23 cases made laparotomy with the liquidation of the obstruction (20 cases - adhesive, in 3 cases - due phytobezoars), in 1 case performed laparoscopically assisted removal of phytobezoar with the elimination of intestinal obstruction.
The average duration of laparoscopic operations amounted to 68.1±26,min. The duration of operation of the open adhesiolysis was 144,2±50,7 min conversion rate was 23%. In the group of patients who underwent laparoscopic interventions, it was noted 1 complication - coagulative necrosis of the wall of the small intestine, which led to the development of postoperative peritonitis. In the group of patients who underwent open adhesions, in 2 patients was marked postoperative subcutaneous mantrala, 1 patient developed early postoperative adhesive obstruction. In all 3 cases it took the relaparotomy. Yet in 1 patient was noted to be a festering wound. The cost of laparoscopic interventions in acute adhesive small bowel obstruction is 5.2% more than the cost of similar interventions in the open way.
Received initial statistical data testify to the feasibility of laparoscopic the elimination of acute small bowel obstruction in the conditions of the municipal health institutions with satisfactory results compared to open surgery. From the economic point of view the cost of laparoscopic operations above the open intervention. However, reduction of term of stay of the patient in hospital and reducing the cost of treatment of complications after laparoscopic operations allow us to consider favorable prospects for performing laparoscopic interventions in the treatment of patients with acute intestinal obstruction.

About the authors

A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation
Central Clinical Hospital, 2A Lenina Str., Reutov, 143964, Russian Federation

Author for correspondence.
Email: doctor_kudryavtsev@mail.ru
Ph.D. Municipal Autonomous institution "Central city clinical hospital, Reutov, head of operational Department; Department of surgery Department of postgraduate education state educational institution of higher professional education Moscow state medical dental University. A.I. Evdokimova, doctoral candidate

A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation
Federal Research and Clinical Center of Specialized Medical Care and Medical Technology of FMBA, 28 Orekhovyi Blvd, Moscow, 115628, Russian Federation

Email: mail@vestnik-surgery.com
MD, Prof. Department of surgery of the Department of postgraduate education state educational institution of higher professional education Moscow state medical dental University. A. I. Evdokimov, head of the Department;

Central Clinical Hospital, 2A Lenina Str., Reutov, 143964, Russian Federation

Email: mail@vestnik-surgery.com
MD, Prof. Municipal Autonomous institution Central city clinical hospital, Reutov, chief doctor

Central Clinical Hospital, 2A Lenina Str., Reutov, 143964, Russian Federation

Email: mail@vestnik-surgery.com
MD. Municipal Autonomous institution "Central city clinical hospital, Reutov, Deputy chief physician for the surgical treatment

A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation
Federal Research and Clinical Center of Specialized Medical Care and Medical Technology of FMBA, 28 Orekhovyi Blvd, Moscow, 115628, Russian Federation

Email: mail@vestnik-surgery.com
Prof. of cafedra surgery Department of postgraduate education state educational institution of higher professional education Moscow state medical dental University. A. I. Evdokimov. Foderalen scientific-clinical center of specialised kinds of medical aid and medical technologies of FMBA of Russia, head of the Department

A.I. Evdokimov Moscow State Medical and Dental University, 20/1 Delegatskaia Str., Moscow, 103473, Russian Federation

Email: mail@vestnik-surgery.com
Department of surgery of the Department of postgraduate education state educational institution of higher professional education Moscow state medical dental University. A.I. Evdokimova, assistant

References

  1. Van Der Krabben A.A., Dijkstra F.R., Nieuwenhuijzen M. i dr. Morbidity and mortality of in advertent eterotomy during adhesiotomy [Zabolevayemost' i smertnost' ot neprednamerennogo enterotomii vo vremya adgeziolizisa]. British Journal of Surgery, 2000; 87: 467–471.
  2. Parker C., Ellis H., Moran B.J. et al.Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery [Spaiki: Posleoperatsionnye desiatiletniaia Posleduiushchaia deiatel'nost' po itogam 12,584 patsientov, perenesshikh operatsiiu na briushnoi polosti bolee nizkuiu]. Dis Colon Rectum., 2001; 44: 822–830.
  3. Ellis. The magnitude of adhesion-related problems [Velichina problem svyazannykh s adgeziyey] . Ann Chir Gynaecol., 1998; 87: 9–11.
  4. Hershlag A., Diamond M.P., DeCherney A.H. Adhesiolysis [adgeziolizis]. Clin Obstet Gynecol., 1991; 34: 395–401.
  5. Monk B.J., Berman M.L., Montz F.J. Adhesions after extensive gynecologic surgery: Clinical significance, etiology and prevention [Spaiki posle obshirnoi ginekologicheskoi khirurgii: Klinicheskaia znachimost', etiologii i profilaktiki]. Am J Obstet Gynecol., 1994; 170: 1396–1403.
  6. Milingos S., Kallipolitis G., Loutradis D. et al. Adhesions: laparoscopic surgery versus laparotomy [Spaiki: laparoskopicheskie operatsii po sravneniiu s laparotomii] Ann. N. Y. Acad. Sci., 2000; 900: 272–285.
  7. Vrijland W.W., Jeekel J., van Geldorp H.J. et al. Abdominal adhesions: intestinal obstruction, pain, and infertility [Spaek v briushnoi polosti: kishechnaia neprokhodimost', boli i besplodie]. Surg Endosc., 2003; 17: 1017–1022.
  8. Catena F., Di Saverio S., Kelly M.D., Biffl W.L. et al. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO) [Bolon'ia Rukovodstvo po diagnostike i upravleniiu Klei Malyi Kishechnaia neprokhodimost' (ASBO):][2010 Evidence-Based Guidelines of the World Society of Emergency Surgery]. World J. Emerg. Surg., 2011; 1: 10.1186/1749-7922-6-5.
  9. Van Der Krabben A., Dijkstra F.R., Nieuwenhuijzen M. i dr. Zabolevayemost' i smertnost' ot neprednamerennogo enterotomii vo vremya spayek. British Journal of Surgery, 2000; 87: 467–471.
  10. Parker C., Wilson M.S., Menzies D. et al.Issledovaniye SCAR-3 : [5-year adhesion-related readmission risk following lower abdominal surgical procedures]. Colorectal Dis., 2005; 7: 551–558.
  11. Grassi R., Romano S., D'Amario F. et al.Aktual'nost' svobodnoy zhidkosti mezhdu petlyami kishechnika, obnaruzhennykh sonografii v klinicheskoy otsenke neprokhodimosti kishechnika u vzroslykh. Eur. J. Radiol., 2004; 50(1): 5–14.
  12. Zalcman M., Sy M., Donckier V., Closset J., Gansbeke D.V. Spiral'naya KT priznaki v diagnostike kishechnoy ishemii v neprokhodimosti tonkoy kishki. Am. J. Roentgenol., 2000; 175(6): 1601–1607.
  13. Di Saverio S., Catena F., Ansaloni L., Gavioli M., Valentino M., Pinna A.D. Vodorastvorimoye kontrastnoye veshchestvo (Gastrografina) znacheniye v kleyevoy tonkoy kishke obstruktsii (ASIO)[ A prospective, randomized, controlled, clinical trial]. World J. Surg., 2008; 32(10): 2293–304.
  14. Diaz J.J. Jr, Bokhari F., Mowery N.T., Acosta J.A., Block E.F., Bromberg W.J., Collier B.R., Cullinane D.C., Dwyer K.M., Griffen M.M., Mayberry J.C., Jerome R. Rukovodstvo po upravleniyu neprokhodimosti kishechnika. J. Trauma, 2008; 64(6): 1651–64.
  15. Agresta F., Paolo De Simone, Natalino Bedin. Laparoskopii v abdominal'noy chrezvychaynykh situatsiyakh[ A Single-Center 10-Year Experience]. Journal of the Society of Laparoendoscopic Surgeons, 2004; 8(1): 25–30.

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