EAES Academy. Mosin S. 01/10/12; 20040
Mr. Sergey Mosin
Mr. Sergey Mosin
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After viewing this presentation, the participant will be able to use laparoscopic methods in treatment of acute small intestinal obstruction widely.
From 2005 to 2010, laparoscopic surgery for acute intestinal obstruction (IO) performed in 71 patients, which accounted 24,9 % from all operations for IO. In 2010 they performed in 39.3% of cases. Among the patients 45.1% were male, mean age was 48,2 ± 16,2 years. Early adhesive IO was observed in 8 patients. In 45 (63,4%) patients the cause of IO was previous surgery, including the early postoperative IO - in 8 (11,3%). Strangulated IO with no prior surgery was observed in 15 (21.1%) patients. Causes of obstructive IO were gallstones in 2 (2.8%) cases and food ball - in 4 (5.6%). Volvulus of sigmoid colon was found in 4 (5.6%) patients, the Cecum mobile - in 1 (1.4%), small intestine - in 1 (1.4%). In 15 (21,1%) patients the cause of obstruction was not clear, and laparoscopy was primarily used for diagnosis.
Results. The ability to perform laparoscopic surgery is evaluated by us both before and during laparoscopy. We refrain from laparoscopic surgery with the expressed enteroparesis, requiring intestinal intubation, or in electrolyte, respiratory or cardiovascular failure.
In the presence of adhesive IO, always follow an open laparoscopy. Rejection of laparoscopic surgery was required in 17 (6.0%) patients, with significant abdominal adhesions or other changes irremovable by laparoscopic surgery.
Places of introducing additional 5mm trocars for were chosen individually. Inspection was performed by palpation guts, detection of cause of obstruction and assessment of severity of adhesions. Adhesiolysis produced by a sharp, if necessary – we used precision monopolar coagulation. When obstructive small bowel obstruction was performed either displacement of food ball into the colon or removal of gallstones through the minilaparotomy. Revealed volvulus of intestine was treat due detorsion.
At early adherent relaparoscopy IO in 3 patients identified the dynamic enteroparesis, thus avoiding futile laparotomy. In other cases, adhesiolysis was performed.
Conversion of laparoscopic surgery was 7 (9.8%) patients.
Passage of intestinal contents was reduced to 2-4 days. Intra-abdominal postoperative complications were not observed. Mortality after laparoscopic surgery was 1.4%.
Conclusions. Of the 88 patients who underwent laparoscopy, 64 (72,7%) surgery was completed laparoscopically.
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