Modern Methods of Preventing Recurrent Adhesive Intestinal Obstruction in Children

Adhesive intestinal obstruction is one of the most urgent problems in pediatric abdominal surgery due to its high rate resulting in a lot of complications, recurrences and relaparotomies. The objective of the research was to examine the clinical efficacy of using intraoperative antiadhesive drugs in children to prevent recurrent adhesive intestinal obstruction. Materials and methods. The examination and analysis of medical records of 86 children with adhesive intestinal obstruction treated in the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University over the past 5 years was carried out. We identified two groups of patients: the comparison group included 40 children who received traditional treatment; the main group included 14 children who underwent the application of antiadhesive gel intraoperatively. The assessment of treatment effectiveness was carried out on the base of the postoperative course (recovery time of intestinal peristalsis, onset of enteral feeding, duration of hospital stay, incidence of early postoperative complications) and long-term outcomes (severity of adhesive disease symptoms, presence of recurrent adhesive intestinal obstruction and relaparotomies). Results and discussion. In comparative evaluation of the postoperative course in two groups of patients we noticed a more favorable course in children of the main group that was shown by faster recovery of peristalsis, reduced duration of gastric stasis, quicker occurrence of self-defecation and shortened term of hospital treatment. In the comparison group recurrent adhesive intestinal obstruction occurred in 8 (20.0%) patients, in 6 (15.0%) cases relaparotomy was performed. In the main group of patients, recurrent adhesive intestinal obstruction was observed in one (7.1%) child; however, relaparotomy was not performed. Conclusions. The intraoperative application of antiadhesive gel is a highly effective and safe way to prevent the recurrence of adhesive intestinal obstruction in children.