Abstrait

Surgical treatment?s possibilities of late adhesive intestinal obstruction in children.

BodnarOleh*, Konoplitskyi Viktor, KhashchukVasyl, ProniaievDmytro, Randiuk Roman

Objectives: To study the adhesions prevalence in the abdominal cavity and to determine the possibilities of surgical treatment of Late Adhesive Intestinal Obstruction (LAIO) in children.

Materials and Methods: 73 children were operated on for LAIO. 35 children were in a comparison group (comprehensive treatment by traditional methods) and 38 children were in the main group. In the main group was used an anti-adhesive solution which containing sodium hyaluronate and decamethoxin to prevent recurrence of Adhesive Intestinal Obstruction (AIO). The following surgical interventions were performed: Adhesiolysis, adhesiolysis and resection of the small intestine, adhesiolysis and making of the ileostomy, elimination of the cause without total adhesiolysis, elimination of the cause without total adhesiolysis and with resection of the small intestine, elimination of the cause without total adhesiolysis and with making of ileostomy. The Adhesion Process (AP) in the abdominal cavity was evaluated by the type of adhesions and their projection on the anterior abdominal wall.

Results: The most common causes of LAIO were adhesive conglomerates (32.88%), moorings (23.28%) and visceral-visceral adhesions (21.92%) in lesser extent visceral-parietal and omentalvisceral adhesions, accordingly 10.96% and 10.96%. In main group recurrent AIO was seen in 3 of 38 children (7.89%) and resolved conservatively. In comparison group recurrent AIO occurred in 7 of 35 children (20%). In comparison group, 4 of 7 children required relaparotomy. The method of cause eliminating was used at AIO without total adhesiolysis using sodium hyaluronate for the operated children. When children were observed between 1 and 7 years, recurrence of AIO was in 1 patient who resolved conservatively.

Conclusion: Mesothelium damaging leads to the emergence of the primary AP of the abdominal cavity with spreading to the surrounding structures and projection on the areas of the anterior abdominal wall. In operations for LAIO in children, it is advisable to use the operation of the cause eliminating (separation or resection of the conglomerates, cutting of the mooring) without total adhesiolysis in combination with intraoperative use of sodium hyaluronate solution with decamethoxine.

Keywords

Late Adhesion Intestinal Obstruction (LAIO), Children.