Prediction of postoperative adhesives intestinal obstruction and its recurrence in children
DOI:
https://doi.org/10.15574/PS.2024.3(84).7379Keywords:
adhesion intestinal obstruction, adhesion process, acetylation phenotype, relapse, prognosis, treatment, prophylaxis, childrenAbstract
It is known that the expressiveness of the adhesion process (AP) depends on the individual characteristics of the connective tissue metabolism. In recent years, the role of acetylation processes in predicting pathological adhesion formation has been actively studied. A genetically determined fast type of acetylation is an unfavorable background for the development of peritoneal adhesion disease (PAD).
Aim - to study the effectiveness of predicting postoperative adhesive intestinal obstruction (AIO) and its recurrence in children based on determining the acetylation phenotype (APh).
Materials and methods. In order to reveal the prognostic value of the acetylation phenotype in the formation of postoperative (AIO), we studied the activity of acetylation in 30 children aged 4-16 years, operated on for appendicular peritonitis (the main group). The control group consisted of 30 somatically healthy children. In addition, a study of APh was conducted in 42 children aged 3-17 years, who underwent surgery for postoperative AIO, to study the informativeness of this test as a prognostic factor for AIO recurrence. APh was established in children by determining the biochemical activity of the enzyme N-acetyltransferase (NAT).
Results. It was established that in children operated on for appendicular peritonitis, in which postoperative AIO occurred, rapid acetylation phenotype (RAP) prevailed (57.14% of children), and in children without signs of AIO, RAP was detected in only one case (6.25%). Among the children operated on for postoperative AIO, the proportion of patients with RAP was even higher (63.64%). Opposite results were noted regarding slow acetylation phenotype (SAP). Among children with recurrent AIO, RAP was detected in 57.14% of cases, and among patients without relapse RAP was diagnosed in 25.0% of children. The opposite pattern was observed in patients with SAP. A direct correlative relationship between NAT activity and the value of the peritoneal adhesion index (PAI) was noted - the higher level of NAT activity, the higher PAI.
Conclusions. Determination of APh in children based on the biochemical activity of the NAT enzyme allows to establish the degree of risk of AIO. AIO and its recurrence are significantly more common in patients with RAP. Detection of RAP in a patient can serve as a prognostic criterion for the severity of AP.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research.
The authors declare no conflict of interest.
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