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.
2. Frager DH, and Baer JW. Role of CT in evaluating patients with small-bowel obstruction,” Seminars in Ultrasound, CT, and MR 1995; 16 (2): 127–140. DOI: 10.1016/0887- 2171(95)90005-5
3. Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, et al. Evaluation and management of small-bowel obstruction: an eastern Association for the Surgery of trauma practice management guideline. Journal of Trauma and Acute Care Surgery. 2012; 73 (5): 362–369. DOI: 10.1097/TA.0b013e31827019de
4. Fevang BT, Fevang J, Stangeland L, Soreide O, K Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Annals of Surgery. 2000; 231 (4): 529–537. DOI: 10.1097/00000658-200004000-00012
5. Cheadle WG, Garr EE, and Richardson JD. The importance of early diagnosis of small bowel obstruction. The American Surgeon. 1988; 54 (9): 565–569. PMID: 3415100
6. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–29. PMID: 3928249
7. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA. (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/ failure. On behalf of the working group on sepsis-related problems of European society of intensive care medicine. Intensive Care Med 1996;22:707–710. DOI: 10.1007/ BF01709751.
8. Anibal B-F, Fabiane A, Gonçalves M, Nicolini EN , de Brito Rodrigues LA, Nunes RS, et al. The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients. A retrospective cohort study. Medicine: June 2019; 98 (26): p e16204/ doi: 10.1097/MD.0000000000016204.
9. Sethi A, Debbarma M, Narang N, Saxena A, Mahobia M, Tomar GS. Impact of targeted preoperative optimization on clinical outcome in emergency abdominal surgeries: A prospective randomized trial. Anesth Essays Res. 2018;12:149- 154. DOI: 10.4103/aer.AER_190_17
10. Kryvoruchko IA and Olefir OS. The Assessment of the Severity of Patients with Generalized Intra-abdominal Infection: An Emphasis on the Predictive Value of Reducing Abdominal Perfusion Pressure in the Complex Treatment of Patients. Acta Scientific Medical Sciences.2021; 5.11: 17-26.
11. Şahin M, Buluş H, Yavuz A, Turhan VB, Öztürk B, KılıçNA, et al. The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias. Ulus Travma Acil Cerrahi Derg. 2020;26(40): 593-599. DOI: 10.14744/tjtes.2020.02500
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. DOI: 10.1097/01. sla.0000133083.54934.ae.
13. Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol. 2011;17:4545–4553. DOI: 10.3748/wjg.v17. i41.4545
14. Mais V. Peritoneal adhesions after laparoscopic gastrointestinal surgery. World J Gastroenterol. 2014;20:4917– 4925. DOI: 10.3748/wjg.v20.i17.4917.
15. Chang Y-J, Yan D-C, Lai J-Y, Chao H-C, Chen C-L, Chen S-E, Tsai M-H. Strangulated small bowel obstruction in children. J Pediatr Surg. 2017;52:1313–1317. DOI: 10.1016/j.jpedsurg.2017.03.002. Epub 2017 Mar 12.
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