POSTOPERATIVE INTESTINAL PARESIS: ENETIC ASPECTS OF PREDICTION AND REATMENT TACTICS CHOICE

Postoperative intestinal paresis is one of the most serious complications of both planned and urgent surgical procedures. To develop new methods of prevention and treatment one needs to do some research on the causes and mechanisms of the intestinal paresis development. And the lack of prognostic criteria for intestinal paresis occurrence, the insufficient effectiveness of existing methods of prevention and treatment require such research. This would significantly improve the treatment outcomes of such patients. The aim of the work: to develop effective methods of prevention and treatment of postoperative intestinal paresis by investigating the causes and mecha-nisms of its development. Materials and methods. 124 patients have been examined. They have undergone planned and urgent laparotomy surgeries. 61 of them revealed postoperative intestinal paresis. All patients were examined using clini-cal, instrumental and laboratory methods. The concentration of serotonin in the blood of patients has been determined. The alleles of polymorphic sections of the 5-HTTLPR gene have been analyzed using a polymerase chain reaction. Results. A comparative assessment of the sero-tonin level in blood plasma and variants of the 5-HTTLPR gene polymorphism has been performed in two groups of patients. The first group included (63 patients). The motor-evacuation function of their intestine has been restored on the second or third day after surgery. The serotonin concentration in the blood plasma has been 242.37±19.88 ng/ml. 49 patients of this group (77.78%) have had the LL-variant of genotype 5-HTTLPR. 6 patients (9.52%) have had the SL variant, and 8 patients (12.70%) have had the SS one. The second group included (61 patients). They have had long-term manifestations of postoperative intestinal paresis. The serotonin level of has been significantly lower (138.72±19.54 ng/ml; p<0.001). The SS-genotype 5-HTTLPR has been detected in 47 patients (77.05%). The SL - genotype variant has occurred in 9 patients (14.75%) and the LL - genotype in 5 patients (8.20%). This suggests that insufficient serotonin activity due to the SS variant of the genotype is associated with the development of postoperative intestinal paresis. Based on this, a method for predicting impaired motor-evacuation function of the intestine has been suggested. In patients with the SS genotype 5-HTTLPR, there is a high probability of postoperative intestinal paresis. A therapeutic tactic has been developed for such patients. It includes the use of the proposed methods of local supply of serotonergic drugs, changes in the scope of the operation. For such patients, we offer an extension of the indications for intestinal intubation by various methods that we have developed and more often to form stoma. It has significantly reduced the incidence of postoperative intestinal paresis and effectively restored the motor-evacuation function of the intestine, signifi-cantly improve the treatment outcomes of such patients. Conclusions: 1. Postoperative disorders of intestinal contractility depend on the adequacy of serotonergic mechanisms of its regulation, which are genetically determined. 2. Predicting the development of postoperative intestinal paresis based on genetic studies allows you to personalize treatment tactics, prevent its development, change the volume of surgery and drug therapy, and improve treatment outcomes.