Comparative results of surgical treatment of patients with acute adhesive small intestinal obstruction

Abstract

Objectives. To evaluate the effectiveness of treatment of acute adhesive intestinal obstruction in a comparative aspect, taking into account the possibilities of modern minimally invasive surgery. Materials and methods. Among those operated on were 62 men aged 20 to 78 years and 65 women aged 21 to 80 years. To evaluate the results of patient treatment, we identified two groups. The main group included 63 patients who were scheduled for laparoscopic adhesiolysis for acute adhesive small intestinal obstruction, and the second control group included 65 patients who underwent open surgery, of whom 6 (9.2%) patients underwent mini-access surgery. All patients underwent laboratory, X-ray, ultrasound and CT examinations to confirm the diagnosis. Risk adjustment for comparing different treatment groups was performed using the ASA score and the P-POSSUM scale before surgery. Results. The duration of hospitalization was reduced (6.1 days in the main group versus 9.7 days in the control group) and the duration of operations (71 minutes versus 107 minutes). After taking into account concomitant diseases and surgical factors, patients who underwent laparoscopic adhesiolysis were less likely to develop serious complications (OR = 0.6; 95% CI 0.48-0.75; p < 0.001) and postoperative complications (OR = 0.21; 95% CI 0.14-0.31; p < 0.0001). Mortality was 3.2% in the laparoscopic group compared with 7.7% in the open group (OR = 0.54; 95% CI 0.31-0.75; p = 0.025). Conclusion. Laparoscopy is a safe and effective method of dissection of adhesions in most patients with postoperative adhesions. This method makes it possible to reduce the length of hospital stay without significantly affecting the incidence of complications and mortality.