Abstract
Adhesive intestinal obstruction is one of the most urgent problems in pediatric abdominal surgery due to its high rate resulting in a lot of complications, recurrences and relaparotomies.
The objective of the research was to examine the clinical efficacy of using intraoperative antiadhesive drugs in children to prevent recurrent adhesive intestinal obstruction.
Materials and methods. The examination and analysis of medical records of 86 children with adhesive intestinal obstruction treated in the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University over the past 5 years was carried out. We identified two groups of patients: the comparison group included 40 children who received traditional treatment; the main group included 14 children who underwent the application of antiadhesive gel intraoperatively. The assessment of treatment effectiveness was carried out on the base of the postoperative course (recovery time of intestinal peristalsis, onset of enteral feeding, duration of hospital stay, incidence of early postoperative complications) and long-term outcomes (severity of adhesive disease symptoms, presence of recurrent adhesive intestinal obstruction and relaparotomies).
Results and discussion. In comparative evaluation of the postoperative course in two groups of patients we noticed a more favorable course in children of the main group that was shown by faster recovery of peristalsis, reduced duration of gastric stasis, quicker occurrence of self-defecation and shortened term of hospital treatment. In the comparison group recurrent adhesive intestinal obstruction occurred in 8 (20.0%) patients, in 6 (15.0%) cases relaparotomy was performed. In the main group of patients, recurrent adhesive intestinal obstruction was observed in one (7.1%) child; however, relaparotomy was not performed.
Conclusions. The intraoperative application of antiadhesive gel is a highly effective and safe way to prevent the recurrence of adhesive intestinal obstruction in children.
References
Blinnikov OI, Dronov AF, Smirnov AN. Laparoscopic surgery for acute adhesive intestinal obstruction in children. In: Laparoscopic surgery. International Congress. Meditsyna; 1993. p. 82-83.
Brochhausen C, Schmitt VH, Hollemann D, et al. Current strategies and future perspectives for intraperitoneal adhesion prevention. J Gastrointest Surg. 2012;16:1256-1274. http://dx.doi.org/10.1007/s11605-011-1819-9 PMid:22297658
Brüggmann D, Tchartchian G, Wallwiener M, et al. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010; 107(44):769-775.
Catena F, Di Saverio S, Kelly MD, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 Evidence Based Guidelines of the World Society of Emergency Surgery. World J Emer Surg. 2011;6(5).
Dubonos AA. Prevention of intra-abdominal adhesion with the help of drug with barrier effect "Mesogel". Extended abstract PhD dissertation. Kursk; 2009.
Kremer PB. Surgical treatment of abdominal adhesive disease with anti-adhesion barrier drugs. Extended abstract PhD dissertation. Volgograd; 2010. 24 p.
Mishalov VH, Byk PL, Leshchyshyn IM, et al. The efficacy and complications of using antiadhesive gel based on carboxymethylcellulose during applying intestinal anastomoses on a background of adhesive process. Khirurgiya Dytjachogo Viku. 2014;1-2(42-43):20-27.
Schnüriger B, Barmparas G, Branco BC et al. Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg. 2011; 201(1): 111-121. http://dx.doi.org/10.1016/j.amjsurg.2010.02.008 PMid:20817145
Tang CL, Jayne DG, Seow-Choen F, et al. A randomized controlled trial of 0.5% ferrichyaluronate gel (Intergel) in the prevention of adhesions following abdominal surgery. Ann Surg. 2006;243:449-455. http://dx.doi.org/10.1097/01.sla.0000207837.71831.a2 PMid:16552194 PMCid:PMC1448972
Zeng Q, Yu Z, You J, et al. Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and metaanalysis. World J Surg. 2007;31(11):2125-2131. http://dx.doi.org/10.1007/s00268-007-9242-9 PMid:17899250
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.