Laparoscopy in the treatment of children with adhesive bowel obstruction
DOI:
https://doi.org/10.15574/PS.2018.59.46Keywords:
postoperative adhesive bowel obstruction, children, laparoscopyAbstract
Adhesive processes in abdominal cavity are a natural process after any surgeries on the abdominal organs and which may predispose the development of postoperative adhesive bowel obstruction (POABO). The question of the possibility and feasibility of using laparoscopy in treatment of patients with POABO is the subject of discussion among both general and paediatric surgeons.Objective: to summarize own experience of using laparoscopy in treatment of children with POABO.
Material and methods. Laparoscopic and laparoscopic-assisted surgeries were performed in 98 children with POABO, who were treated at the I Surgery Department of Lviv Oblast Children’s Clinical Hospital «OHMATDYT» during 2006-2017 years. Carboxyperitoneum was created by open Hasson technique with a working pressure of 5-10 mm Hg, depending on the child's age. During laparoscopy 3- or 5-mm instruments were used. Adhesiolysis was performed by applying a mono- or bipolar coagulator, and in some cases by LigaSure® device or an ultrasonic scalpel.
Results. The signs of chronic POABO had 64.3% of patients and acute POABO – 35.7% of children. In 66.7% of children with chronic POABO, adhesiolysis was done completely laparoscopically, and the conversion was provided in 33.3% of cases due to the presence of multiple dense adhesions. Laparoscopic adhesiolysis was performed in 65.7% of children with acute POABO, and laparoscopically-assisted procedures – in 34.3% cases due to necessity of the intestinal loop resection. In this case, adhesiolysis and mobilization of the bowel loop was done laparoscopically, and the resection and applying of anastomosis – extraperitoneally. Adhesiolysis managed to complete laparoscopically in 66.3% of patients, although 29.2% of them had signs of peritonitis. The conversion rate was 21.4% and was due to the presence of numerous dense adhesions. From the technical point of view, laparoscopy in children with POABO is a complex and long-lasting surgery. In our study, adhesiolysis in 37.5% of children with multiple dense adhesions was performed completely laparoscopically, by that the operation duration was significantly longer as compared to the surgeries associated with single adhesions (264.2±17.3 min and 112.8±8.7 min, respectively, p<0.05).
Conclusions. With a careful patient selection, laparoscopic adhesiolysis is a safe and effective method of treatment children with postoperative adhesive bowel obstruction. The presence of peritonitis is not a contraindication to laparoscopy, and in case of necessity of the intestinal loop resection, it’s possible to do laparoscopic-assisted surgery.
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