Mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction

Abstract

Modern technologies in surgery lead to an increase in the number of surgical interventions, which in turn increases the number of patients with peritoneal adhesions disease. Patients with acute adhesive small intestinal obstruction make up to 70 %. Acute adhesion small intestinal obstruction takes the leading place among mechanical forms of intestinal obstruction and reaches 63–80 %, and the mortality rate is 5.1–8.4 %. The aim. Improvement of minimally invasive technologies in the treatment of patients with adhesive small intestinal obstruction. Materials and methods. The main group – 99 (58.6 %) patients with adhesions of the small intestine, who underwent minimally invasive treatment technologies. The comparison group included 70 (41.4 %) patients with acute adhesion small intestinal obstruction, who were treated with traditional methods. Results. Based on clinical laboratory and instrumental research results, 21 (12.4 %) patients out of 169 patients underwent emergency surgery: 7 (10.0 %) patients of the comparison group and 14 (14.1 %) patients of the main group. Minimally invasive surgical intervention was performed in 45 (45.5 %) patients of the main group with viscerolysis in 29 (29.3 %) patients and conversion was performed in 16 (16.2 %) patients. Median laparotomy was performed in 54 (54.5 %) patients of the main group and in 70 (100.0 %) patients of the comparison group. The complications of acute adhesive small intestinal obstruction and the complications of the postoperative period in the comparative analysis of the results of the treatment of patients were taken into account. The grading of postoperative complications was carried out in accordance with the classification of P. A. Clavien and D. Dindo (2009), according to which a statistically significant difference is noted in the studied groups: 14 (14.1 %) of the main group and 23 (32.8 %) of the comparison group, III, IV and V degrees of complications were preferred. Relaparotomy was performed in 5 (7.1 %) patients of the comparison group and in 2 (2.0 %) patients of the main group. Mortality decreased from 6 (8.5 %) in the comparison group to 2 (2.0 %) in the main group. Conclusions. The use of an improved approach in diagnostics and treatment of patients with acute adhesion small intestinal obstruction ensured improved results of surgical treatment. The use of mini-invasive technologies in diagnosis and treatment made it possible to reduce the frequency of postoperative complications from 32.8 % to 14.1 %, the mortality rate from 8.5 % to 2.0 %, which confirms the effectiveness of the use of mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction.