LAPAROSTOMA IN A SURGICAL TREATMENT OF ACUTE OBSTRUCTION OF THE SMALL INTESTINE

Aim: Improvement of the results of surgical treatment of patients with AOSI by using laparostomy. Methods. We conducted a comprehensive ex-amination of 221 patients with AOSI, who underwent various surgical interventions aimed at eliminating ob-struction. Treatment of AOSI against the background of acute widespread peritonitis in this group was performed in 17 (7.69 %) patients. The state of the motor-evacuation function of the gastrointestinal tract, the state of nonspecific resistance of the body were evaluated. In the postoperative period, intra-abdominal pressure was determined (I. Kron and co- authors (1998)). Results. A retrospective analysis of patients with acute obstruction of small intestine with an unfavorable course of the disease revealed that chronic comorbidity (comorbidity index 5.5-6.07) was detected in 30 patients (93.8%); surgical and anesthesia risk according to the ASA IV-V scale was observed in 87.5% of patients; the choice of inadequate for a particular surgical situation method of decompression of the digestive tract - in 25 patients (78.13%); misinterpretation of small bowel viability - in 12 cases (37.5%). In 96.67% of cases there was a lack and suppression of motor-evacuation function of the digestive tract, which also contributed to the lethal outcome due to increased intra-abdominal pressure and the appearance of multiple organ syndrome in 26 (81.25%) patients. Laparostomy was used in only one patient during primary surgery and in two during relaparotomy. In patients with AOSI who were subsequently resected the affected area of the digestive canal before surgery, there were significant violations of motor activity of the digestive tract in the form of depression or lack of motility - in 81.82% of patients, its strengthening - in 13.64% of patients and in one case - motor disorders of digestive tract have not yet been observed. In 9 patients with acute obstruction of small in-testine on the background of widespread purulent-fibrinous peritonitis formed a primary entero-enteroanastomosis with laparostomy according to their own method. Before suturing the abdominal cavity and after its drainage on the large omentum or, in its absence, on the loop of the small intestine was applied perforated smooth film, which was previously stitched with ligature and removed through the lower incision of the laparosto-my. Fences of 6–8 PCV tubes were laid on top of the film, before stitching them with synthetic thread in three places. Using these threads, the PCV tube was fixed to the abdominal wall by stitching the anterior abdominal wall from the inside out. In a satisfactory course of the disease (according to clinical, sonographic criteria for restoration of motor-evacuatory function of the digestive tract) by dissection of synthetic fibers, was performed gradual removal of 2-3 PCV tubes per day and perforated film using intraoperatively ligature, during which it was stitched . The advantage of the proposed laparostomy is the absence of the need for repeated laparotomy to close the laparostomy, prevention of intra-abdominal hypertension, aeration of the abdominal cavity, possible control over the condition of the abdominal cavity and, if necessary, the ease of re-rehabilitation. Conclusions. The use of a laparostomy in pa-tients with AOSI in conditions of widespread peritonitis helps to prevent the development of compartment syn-drome, aeration of the abdominal cavity and improves the course of the postoperative period, also allowsto monitor the state of the abdominal organs after surgery, reduce the number of relaparotomies and general anesthesia when closing the laparostomy.