Acute adhesive small-bowel obstruction: laparotomy or laparoscopy

Abstract

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment.

Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders.

Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy).

Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

Keywords

acute adhesive small-bowel obstruction / ultrasound examination / X-ray computed tomography / intraperitoneal hypertension / laparoscopic adhesiolysis

References

[1] Chekmazov I.A. Spaechnaya bolezn' bryushiny. (Adhesive disease of peritoneum.) Moscow: GEOTAR-Media. 2008; 160 p. (In Russ.)

[2] Чекмазов И.А. Спаечная болезнь брюшины. М.: ГЭОТАР-Медиа. 2008; 160 c.

[3] Tarakanov V.A., Kolesnikov E.G. Late adhesive intestinal obstruction in childhood: diagnostic algorithm. Kubanskiy nauchnyy meditsinskiy vestnik. 2009; 109 (4): 50–54. (In Russ.)

[4] Тараканов В.А., Колесников Е.Г. Поздняя спаечная кишечная непроходимость в детском возрасте: диагностический алгоритм. Кубанский науч. мед. вестн. 2009; 109 (4): 50-54.

[5] Timofeev M.E., Volkov V.V., Shapoval'yants S.G. Acute early adhesive small bowel obstruction: today`s possibilities of laparoscopy in diagnosis and treatment. Endoskopicheskaya khirurgiya. 2015; 21 (2): 36–52. (In Russ.)

[6] Тимофеев М.Е., Волков В.В., Шаповальянц С.Г. Острая ранняя спаечная тонкокишечная непроходимость на современном этапе: возможности лапароскопии в диагностике и лечении. Эндоскопич. хир. 2015; 21 (2): 36-52.

[7] Catena F., Di Saverio S., Kelly M.D. 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. Emerg. Surg. 2011; 6: 5. DOI: 10.1186/1749-7922-6-5.

[8] Khubutiya M.Sh., Yartseva P.A. Endokhirurgiya pri neotlozhnykh zabole­vaniyakh i travme. Rukovodstvo. (Endosurgery in case of acute diseases and trauma. Guidance.) Moscow: GEOTAR-Media. 2014; 240 p. (In Russ.)

[9] Хубутия М.Ш., Ярцева П.А. Эндохирургия при неотложных заболеваниях и травме. Руководство. М.: ГЭОТАР-Медиа; 2014; 240 c.

[10] Radzikhovskiy A.P., Kolesnikov E.B., Mendel' N.A. Laparoscopic diagnosis and treatment of acute intestinal obstruction. Khirurgiya Ukrainy. 2010; (2): 89–94. (In Russ.)

[11] Радзиховский А.П., Колесников Е.Б., Мендель Н.А. Лапароскопическая диагностика и лечение острой тонкокишечной непроходимости. Хирургия Украины. 2010; (2): 89-94.

[12] Dobrokvashin S.V., Volkov D.E., Izmaylov A.G. Some aspects of treatment of patients with acute intestinal obstruction. Vestnik sovremennoy klinicheskoy meditsiny. 2014; (5): 53–55. (In Russ.)

[13] Доброквашин С.В., Волков Д.Е., Измайлов А.Г. Некоторые аспекты лечения больных с острой кишечной непроходимостью. Вестн. соврем. клин. мед. 2014; (5): 53-55.

[14] Di Saverio S., Coccolini F., Galati M. et al. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2013 update of the Evidence-Based Guidelines from the World Society of Emergency Surgery ASBO working group. World J. Emerg. Surg. 2013; 8: 42. DOI: 10.1186/1749-7922-8-42.

[15] Maung A.A., Johnson D.C., Piper G.L. et al. Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline. J. Trauma Acute Care Surg. 2012; 73: 362–369. DOI: 10.1097/TA.0b013e31827019de.

[16] Maung A.A., Johnson D.C., Piper G.L. et al. Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline. J. Trauma Acute Care Surg. 2012; 73: 362-369. DOI: 10.1097/TA.0b013e31827019de.

[17] Kozlova Yu.A., Mumladze R.B., Olimpiev M.Yu. The role of X-ray computed tomography in the diagnosis of intestinal obstruction. Annaly khirurgii. 2013; (4): 5–11. (In Russ.)

[18] Козлова Ю.А., Мумладзе Р.Б., Олимпиев М.Ю. Роль рентгеновской компьютерной томографии в диагностике кишечной непроходимости. Анн. хир. 2013; (4): 5-11.

[19] Malkov I.S. Izbrannye razdely neotlozhnoy abdominal'noy khirurgii. Monografiya. (Selected sections of emergency abdominal surgery. Monograph.) Kazan': izdatel'stvo Kazanskogo gosudarstvennogo tekhnicheskogo universiteta. 2013; 408 p. (In Russ.)

[20] Малков И.С. Избранные разделы неотложной абдоминальной хирургии. Монография. Казань: издательство Казанского гос. техн. ун-та. 2013; 408 с.

[21] Burch J., Moore E., Moore F., Franciose R. The abdominal compartment syndrome. Surg. Clin. North Am. 1992; 76: 833–842. DOI: 10.1016/S0039-6109(05)70483-7.

[22] Burch J., Moore E., Moore F., Franciose R. The abdominal compartment syndrome. Surg. Clin. North Am. 1992; 76: 833-842. DOI: 10.1016/S0039-6109(05)70483-7.

[23] Blinnikov O.I., Dronov A.F., Smirnov A.N. Laparoskopicheskie operatsii pri ostroy spaechnoy kishechnoy neprokhodimosti u detey. (Laparoscopic surgery for acute adhesive intestinal obstruction in children.) Materialy mezhdunarodnogo kongressa. Moscow, 1993; 82–88. (In Russ.)

[24] Блинников О.И., Дронов А.Ф., Смирнов А.Н. Лапароскопические операции при острой спаечной кишечной непроходимости у детей. Материалы международного конгресса. М. 1993; 82-88.

RIGHTS & PERMISSIONS

Malkov I.S., Bagautdinov E.B., Sharafislamov I.F., Zogot S.R., Misiev D.K.