Prediction and prevention of intra-abdominal adhesions after appendectomy

Introduction. The intra-abdominal adhesions develop in 14.0% of patients after the abdominal operations and in 90.0-96.0% after repeated interventions.

The aim of the study was to detect a group of patients prone to the development of postoperative intra-abdominal adhesions and to study the effectiveness of anti-adhesion therapy for their treatment.

Material and methods. In the study we compared clinical outcomes of 94 patients with acute appendicitis (AA): an open appendectomy was performed in 38 (40.4%) patients, laparoscopic – 56 (59.6%). Inclusion criteria were: disease duration no more than 2 days. Exclusion criteria were: an adhesive disease in the anamnesis, patients with AA complications such as diffuse peritonitis, infiltrates in the abdominal cavity. There were 29 men (30.8%), 65 women (69.2%). The age of patients ranged from 20 to 69 years. As we found, the development of postoperative intra-abdominal adhesions was predicted under the following conditions: an increased concentration of C-reactive protein in the blood serum from 85.0 mg / l to 250.0 mg / l, serum amyloid A from 10.0-15.0 mg / l to 100.0 mg / l and lipopolysaccharide-binding protein from 4.2 mg / l to 5.0 mg / l by the 3rd day of the postoperative period, and an increased concentration of C-reactive protein for more than 250.0 mg / l, serum amyloid A more than 100.0 mg / l, and lipopolysaccharide-binding protein of the blood serum more than 5.0 mg / l by the 7th day, comparing with the preoperative parameters, respectively (patent No. RU 2840490).

The first group (control) included 53 patients who did not have a tendency to form postoperative intra-abdominal adhesions. The second group (main) consisted of 41 patients who were predisposed to the development of postoperative adhesive process in the abdominal cavity. Each of the groups was divided into 2 subgroups: patients of subgroup A did not receive anti-adhesion therapy; patients of subgroup B were applied the techniques of "Fast-Track" surgery during the operation and carried out a set of anti-adhesion measures.

Results. In patients of the control group, the concentration of the studied proteins by day 3 after appendectomy was increased compared to the preoperative values: CRP - by 23.5%; SAA - by 31%; LBS - by 4.5%. A week after the operation, these parameters tended to decrease up to preoperative values. In patients of the main group, the concentration of peripheral blood proteins, was increased more significantly after appendectomy compared to preoperative parameters: CRP - by 41.8%; SAA - by 70.0%; LBS - by 11.4%. A week after the operation, the concentrations of the studied proteins in the peripheral blood tended to increase: CRP - by 77.6%; SAA - by 156.0%; LBS - by 42.2%. Each group was divided into 2 subgroups: patients of subgroup A did not receive antiadhesion therapy, patients of subgroup B were applied Fast-Track surgery techniques during the operation and a set of antiadhesion measures: in the first 2 days, intravenous administration of ozonized 0.9% NaCl solution (concentration 1.2 mg/l); longidaza 3000 U intramuscularly #3 starting from the 4th day; outpatient magnetotherapy - #4, and then laser therapy - #4; according to indications, 4 weeks after the operation, electrophoresis of longidaza 500 U #5. The proposed set of diagnostic and therapeutic measures allowed reducing the developing postoperative intra-abdominal adhesions by 3.1 times.

Conclusion. Inclusion of such criteria as acute phase proteins of inflammation in the protocols of surgical patient examination allows predicting with high accuracy the developing intra-abdominal adhesions after appendectomy, and, based on this data, forming groups of patients who are indicated for anti-adhesion therapy in order to reduce the risk of the developing adhesive process. Studying the dynamics of the number of agglutination reactions of patients' peripheral blood serum in different dilutions with an antigen adhesion complex immobilized on a magnoimmunosorbent test system allows evaluating the effectiveness of anti-adhesion measures.