Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

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Abstract


Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 1–2% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 50–70% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases — these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р < 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p < 0,01).


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About the authors

Badri V. Sigua

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: dr.sigua@gmail.com
ORCID iD: 0000-0002-4556-4913

Russian Federation, Saint-Petersburg

doctor of science, professor of the Department of Faculty Surgery named after I.I. Grekov

Vyacheslav P. Zemlyanoy

North-Western State Medical University named after I.I. Mechnikov

Email: vyacheslav.zemlyanoy@szgmu.ru
ORCID iD: 0000-0001-7368-5926

Russian Federation, Saint Petersburg

doctor of medical sciences, professor, head of the department of faculty surgery named after I.I. Grekov

Sergey V. Petrov

North-West State Medical University named after I.I. Mechnikov

Email: psvsurg@mail.ru
ORCID iD: 0000-0003-4398-5770

Russian Federation, Saint Petersburg

doctor of medical sciences, professor of the department of operative and clinical surgery with topographic anatomy named after S.A. Simbirtsev

Diyora H. Qalandarova

North-West State Medical University named after I.I. Mechnikov

Email: diyorakalandarova931@gmail.com
ORCID iD: 0000-0002-8497-8553

Russian Federation, Saint Petersburg

attachment of the department of faculty surgery named after I.I. Grekov.

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Supplementary files

Supplementary Files Action
1.
The developed scheme of diagnostics and treatment presented in the form of an algorithm. ОСТН — acute adhesive small bowel obstruction (ASBO); МСКТ — multisection spiral CT; ВЭГДС — videoesophagogastroduodenoscopy

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Copyright (c) 2021 Sigua B.V., Zemlyanoy V.P., Petrov S.V., Qalandarova D.H.

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