Research Article
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Evaluation of adhesive ileus risk factors and treatment modalities among the patients undergoing laparotomy

Year 2017, Volume: 8 Issue: 4, 191 - 197, 15.12.2017
https://doi.org/10.18663/tjcl.354248

Abstract

Aim: Postoperative
adhesions become a serious clinical state both for the patients and physicians,
in case of reoperation, because adhesions make exploration difficult, may
induce organ injury and so increases the operative time. In this study we aimed
to asses the factors influencing the developement of brid ileus and to analyse
the results of treatment.

Material and Methods: In terms of adhesive 
ileus development, a retrospevtive review of laparatomy performed
patients in our hospital’s pediatric surgery department was conducted.

Results: In this study 3271 patients were included. Most common indication
for prior laparotomy was appendicitis (66%). Median age was 8,2 years and 61%
of patients were male. Median follow up period was 5 years. Adhesive ileus
occurred in 152 patients (4.6%). 88% of adhesive ileus occurred within the
first 6 months and 99% within first 3 years. There were no significant
relationship among patient age, gender and adhesive ileus development. 23% of
the all cases were soiled abdominal procedures. The incidence of adhesive ileus
was 3,4% after clean procedures and 10,9% after contaminated and soiled abdominal
procedures. The drainage materials that were used following contaminated
operations did not affect the development of adhesive ileus. Mean operation
time was 60 minutes. It was observed that prolonged operation time increased
the development of adhesive ileus,
and also exploring additional pathologies
such as Meckel’s diverticulum
increased adhesive ileus incidence 3 times
more.

Conservative treatment was successful in 61% of the patients with adhesive
ileus and only %39 of them were operated for adhesions. Patients under the age
of one with adhesive ileus required surgical correction more frequently than
the other age groups. The success rate of conservative treatment was higher in
patients who are older than 1 year old and in the setting of first adhesive
ileus attack.









Conclusion: This study demonstrated that traumatic and unnecessary interventions to
tissues, prolonged surgery time and intraperitoneal contamination during the
operation have increased the adhesive ileus development. Additionally, we suppose
that conservative treatment of adhesive ileus in children has high success
rate. 

References

  • 1. Drollette CM, Badawy S. Pathophysiology of pelvic adhesions. Modern trends in preventing infertility. J Reprod Med 1992; 37: 107.
  • 2. Menzies D. Peritoneal adhesions. Incidence, cause, and prevention. Surg Annu 1992; 24: 27-45.
  • 3. Bonnard A, Kohaut J, Sieurin A, Belarbi N, El Ghoneimi A. Gastrografin for uncomplicated adhesive small bowel obstruction in children. Pediatr Surg Int 2011; 27: 1277-81.
  • 4. Grant HW, Parker MC, Wilson MS, et al. Population-based analysis of the risk of adhesion-related readmissions after abdominal surgery in children. J Pediatr Surg 2006; 41: 1453-56.
  • 5. Grant HW, Parker MC, Wilson MS, et al. Adhesions after abdominal surgery in children. J Pediatr Surg 2008; 43: 152-57.
  • 6. Reijnen M, Bleichrodt R, Van Goor H. Pathophysiology of intra‐abdominal adhesion and abscess formation, and the effect of hyaluronan. Brit J Surg 2003; 90: 533-41.
  • 7. Luijendijk R, De Lange D, Wauters C, et al. Foreign material in postoperative adhesions. Ann Surg 1996; 223: 242.
  • 8. Ahlberg G, Bergdahl S, Rutqvist J, Soderquist C, Frenckner B. Mechanical small-bowel obstruction after conventional appendectomy in children. Eur J Pediatr Surg 1997; 7: 13-15.
  • 9. Wilkins BM, Spitz L. Incidence of postoperative adhesion obstruction following neonatal laparotomy. Brit J Surg 1986; 73: 762-64.
  • 10. Young JY, Kim DS, Muratore CS, Kurkchubasche AG, Tracy Jr TF, Luks FI. High incidence of postoperative bowel obstruction in newborns and infants. J Pediatr Surg 2007; 42: 962-65.
  • 11. Aguayo P, Ho B, Fraser JD, Gamis A, St Peter SD, Snyder CL. Bowel obstruction after treatment of intra-abdominal tumors. Eur J Pediatr Surg 2010; 20: 234-36.
  • 12. Choudhry MS, Grant HW. Small bowel obstruction due to adhesions following neonatal laparotomy. Pediatr Surg Int 2006; 22: 729-32.
  • 13. Eeson GA, Wales P, Murphy JJ. Adhesive small bowel obstruction in children: should we still operate? J Pediatr Surg 2010; 45: 969-74.
  • 14. Lautz TB, Raval MV, Reynolds M, Barsness KA. Adhesive Small Bowel Obstruction in Children and Adolescents: Operative Utilization and Factors Associated with Bowel Loss. J Am Coll Surgeons 2011; 212: 855-61.
  • 15. Al-Salem AH, Oquaish M. Adhesive Intestinal Obstruction in Infants and Children: The Place of Conservative Treatment. ISRN Surg 2011.
  • 16. Tsao KJ, St Peter SD, Valusek PA, et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 2007; 42: 939-42.
  • 17. Down R, Whitehead R, Mck Watts J. Why do surgical packs cause peritoneal adhesions? Aust Nz J Surg 1980; 50: 83-85.
  • 18. Grahame GR, Torchia MG, Dankewich KA, Ferguson IA. Surface-active material in peritoneal effluent of CAPD patients. Periton Dialysis Int 1985; 5: 109-11.
  • 19. Nadrowski L. Paralytic ileus: recent advances in pathophysiology and treatment. Current Surgery 1983; 40: 260.
  • 20. Feigin E, Kravarusic D, Goldrat I, et al. The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction. J Pediatr Surg 2010; 45: 966-68.
  • 21. Kaselas C, Molinaro F, Lacreuse I, Becmeur F. Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience. J Pediatr Surg 2009; 44: 1581-85.
  • 22. Khairy GA, Afzal MF, Murshid KR, Guraya S, Ghallab A. Post appendectomy small bowel obstruction. Saudi Med J 2005; 26: 1058-60.
  • 23. Dijkstra F, Nieuwenhuijzen M, Reijnen M, Van Goor H. Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions. Scand J Gastroenterol Suppl 2000; 232: 52-59.
  • 24. Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995; 222: 120.
  • 25. Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery 1994; 115: 433.
  • 26. Bizer L, Liebling R, Delany H, Gliedman M. Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery 1981; 89: 407.
  • 27. Brolin RE, Krasna MJ, Mast BA. Use of tubes and radiographs in the management of small bowel obstruction. Ann Surg 1987; 206: 126.
  • 28. Seror D, Feigin E, Szold A, et al. How conservatively can postoperative small bowel obstruction be treated? Am J Surg 1993; 165: 121-26.
  • 29. Vijay K, Anindya C, Bhanu P, Mohan M, Rao P. Adhesive small bowel obstruction (ASBO) in children-role of conservative management. Med J Malaysia 2005; 60: 81.

Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi

Year 2017, Volume: 8 Issue: 4, 191 - 197, 15.12.2017
https://doi.org/10.18663/tjcl.354248

Abstract

Amaç: Postoperatif yapışıklıklar
intestinal obstrüksüyona yol açması, reoperasyon durumlarında abdominal
eksplorasyonu zorlaştırması, organ yaralanmalarına sebep olması nedeniyle hem
hasta hem de hekimler için önemli bir klinik durumdur. Bu çalışmada brid ileus
gelişimine etki eden faktörlerin saptanması ve brid ileusdaki tedavi
sonuçlarının değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: 2005-2010 yılları arasında çeşitli nedenlerle laparotomi yapılan 
hastalar brid ileus gelişimi açısından retrospektif olarak
değerlendirildi.

Bulgular: Bu çalışmaya laparotomi yapılan 3271 hasta dahil edildi. Apandisit
en sık laparotomi endikasyonuydu (%66). 152 hastada (%4,6) postoperatif brid
ileus geliştiği tespit edildi. Bunların %88’inin postoperatif ilk 6 ayda,
%99’unun da ilk 3 yıl içinde geliştiği görüldü. Yaş ve cinsiyet ile brid ileus
gelişimi arasında ilişki yoktu. Vakaların %23’ü kirli vasıfta ameliyatlardı.
Temiz, temiz kontamine ameliyatlardan sonra brid ileus gelişme oranı %3,4 iken,
kontamine ve kirli ameliyatlardan sonra bu oran %10,9 olarak bulundu. Batın içerisine
dren yerleştirilmesinin brid ileus gelişimini etkilemediği saptandı. Ameliyat
süresi uzadıkça postoperatif brid ileus gelişme oranının arttığı tespit edildi.
Ayrıca ameliyatta Meckel divertikülü gibi ek patolojiler araştırılan hastalarda
brid ileus gelişme oranının 3 kat arttırdığı görüldü.

Brid ileus gelişen hastaların %61’i nonoperatif-konservatif
yollarla tedavi edilirken %39’unda cerrahi girişim gerektiği tespit edildi.









Sonuçlar: Çalışmamızda batın içinde
uygulanan ek girişimlerin, operasyon süresinin uzun olmasının ve
intraperitoneal kontaminasyonun brid ileus gelişimini artırdığı gösterilmiştir.
Bu konulara dikkat edilmesinin brid ileus gelişimini azaltabileceği
düşünülmüştür. Çocuk yaş grubunda uygun vakalarda konservatif tedavi ile daha
yüksek oranlarda başarı sağlanabileceği kanısına varılmıştır.

References

  • 1. Drollette CM, Badawy S. Pathophysiology of pelvic adhesions. Modern trends in preventing infertility. J Reprod Med 1992; 37: 107.
  • 2. Menzies D. Peritoneal adhesions. Incidence, cause, and prevention. Surg Annu 1992; 24: 27-45.
  • 3. Bonnard A, Kohaut J, Sieurin A, Belarbi N, El Ghoneimi A. Gastrografin for uncomplicated adhesive small bowel obstruction in children. Pediatr Surg Int 2011; 27: 1277-81.
  • 4. Grant HW, Parker MC, Wilson MS, et al. Population-based analysis of the risk of adhesion-related readmissions after abdominal surgery in children. J Pediatr Surg 2006; 41: 1453-56.
  • 5. Grant HW, Parker MC, Wilson MS, et al. Adhesions after abdominal surgery in children. J Pediatr Surg 2008; 43: 152-57.
  • 6. Reijnen M, Bleichrodt R, Van Goor H. Pathophysiology of intra‐abdominal adhesion and abscess formation, and the effect of hyaluronan. Brit J Surg 2003; 90: 533-41.
  • 7. Luijendijk R, De Lange D, Wauters C, et al. Foreign material in postoperative adhesions. Ann Surg 1996; 223: 242.
  • 8. Ahlberg G, Bergdahl S, Rutqvist J, Soderquist C, Frenckner B. Mechanical small-bowel obstruction after conventional appendectomy in children. Eur J Pediatr Surg 1997; 7: 13-15.
  • 9. Wilkins BM, Spitz L. Incidence of postoperative adhesion obstruction following neonatal laparotomy. Brit J Surg 1986; 73: 762-64.
  • 10. Young JY, Kim DS, Muratore CS, Kurkchubasche AG, Tracy Jr TF, Luks FI. High incidence of postoperative bowel obstruction in newborns and infants. J Pediatr Surg 2007; 42: 962-65.
  • 11. Aguayo P, Ho B, Fraser JD, Gamis A, St Peter SD, Snyder CL. Bowel obstruction after treatment of intra-abdominal tumors. Eur J Pediatr Surg 2010; 20: 234-36.
  • 12. Choudhry MS, Grant HW. Small bowel obstruction due to adhesions following neonatal laparotomy. Pediatr Surg Int 2006; 22: 729-32.
  • 13. Eeson GA, Wales P, Murphy JJ. Adhesive small bowel obstruction in children: should we still operate? J Pediatr Surg 2010; 45: 969-74.
  • 14. Lautz TB, Raval MV, Reynolds M, Barsness KA. Adhesive Small Bowel Obstruction in Children and Adolescents: Operative Utilization and Factors Associated with Bowel Loss. J Am Coll Surgeons 2011; 212: 855-61.
  • 15. Al-Salem AH, Oquaish M. Adhesive Intestinal Obstruction in Infants and Children: The Place of Conservative Treatment. ISRN Surg 2011.
  • 16. Tsao KJ, St Peter SD, Valusek PA, et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 2007; 42: 939-42.
  • 17. Down R, Whitehead R, Mck Watts J. Why do surgical packs cause peritoneal adhesions? Aust Nz J Surg 1980; 50: 83-85.
  • 18. Grahame GR, Torchia MG, Dankewich KA, Ferguson IA. Surface-active material in peritoneal effluent of CAPD patients. Periton Dialysis Int 1985; 5: 109-11.
  • 19. Nadrowski L. Paralytic ileus: recent advances in pathophysiology and treatment. Current Surgery 1983; 40: 260.
  • 20. Feigin E, Kravarusic D, Goldrat I, et al. The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction. J Pediatr Surg 2010; 45: 966-68.
  • 21. Kaselas C, Molinaro F, Lacreuse I, Becmeur F. Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience. J Pediatr Surg 2009; 44: 1581-85.
  • 22. Khairy GA, Afzal MF, Murshid KR, Guraya S, Ghallab A. Post appendectomy small bowel obstruction. Saudi Med J 2005; 26: 1058-60.
  • 23. Dijkstra F, Nieuwenhuijzen M, Reijnen M, Van Goor H. Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions. Scand J Gastroenterol Suppl 2000; 232: 52-59.
  • 24. Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995; 222: 120.
  • 25. Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery 1994; 115: 433.
  • 26. Bizer L, Liebling R, Delany H, Gliedman M. Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery 1981; 89: 407.
  • 27. Brolin RE, Krasna MJ, Mast BA. Use of tubes and radiographs in the management of small bowel obstruction. Ann Surg 1987; 206: 126.
  • 28. Seror D, Feigin E, Szold A, et al. How conservatively can postoperative small bowel obstruction be treated? Am J Surg 1993; 165: 121-26.
  • 29. Vijay K, Anindya C, Bhanu P, Mohan M, Rao P. Adhesive small bowel obstruction (ASBO) in children-role of conservative management. Med J Malaysia 2005; 60: 81.
There are 29 citations in total.

Details

Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ahmet Ertürk

İbrahim Karaman

Ayşe Karaman

Engin Yılmaz This is me

Çağatay Evrim Afşarlar This is me

Derya Erdoğan

Yusuf Hakan Çavuşoğlu

Özlem Balcı

İsmet Faruk Özgüner

Publication Date December 15, 2017
Published in Issue Year 2017 Volume: 8 Issue: 4

Cite

APA Ertürk, A., Karaman, İ., Karaman, A., Yılmaz, E., et al. (2017). Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi. Turkish Journal of Clinics and Laboratory, 8(4), 191-197. https://doi.org/10.18663/tjcl.354248
AMA Ertürk A, Karaman İ, Karaman A, Yılmaz E, Afşarlar ÇE, Erdoğan D, Çavuşoğlu YH, Balcı Ö, Özgüner İF. Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi. TJCL. December 2017;8(4):191-197. doi:10.18663/tjcl.354248
Chicago Ertürk, Ahmet, İbrahim Karaman, Ayşe Karaman, Engin Yılmaz, Çağatay Evrim Afşarlar, Derya Erdoğan, Yusuf Hakan Çavuşoğlu, Özlem Balcı, and İsmet Faruk Özgüner. “Laparotomi yapılan Hastalarda Brid Ileus Risk faktörleri Ve Tedavi yaklaşımlarının değerlendirilmesi”. Turkish Journal of Clinics and Laboratory 8, no. 4 (December 2017): 191-97. https://doi.org/10.18663/tjcl.354248.
EndNote Ertürk A, Karaman İ, Karaman A, Yılmaz E, Afşarlar ÇE, Erdoğan D, Çavuşoğlu YH, Balcı Ö, Özgüner İF (December 1, 2017) Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi. Turkish Journal of Clinics and Laboratory 8 4 191–197.
IEEE A. Ertürk, “Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi”, TJCL, vol. 8, no. 4, pp. 191–197, 2017, doi: 10.18663/tjcl.354248.
ISNAD Ertürk, Ahmet et al. “Laparotomi yapılan Hastalarda Brid Ileus Risk faktörleri Ve Tedavi yaklaşımlarının değerlendirilmesi”. Turkish Journal of Clinics and Laboratory 8/4 (December 2017), 191-197. https://doi.org/10.18663/tjcl.354248.
JAMA Ertürk A, Karaman İ, Karaman A, Yılmaz E, Afşarlar ÇE, Erdoğan D, Çavuşoğlu YH, Balcı Ö, Özgüner İF. Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi. TJCL. 2017;8:191–197.
MLA Ertürk, Ahmet et al. “Laparotomi yapılan Hastalarda Brid Ileus Risk faktörleri Ve Tedavi yaklaşımlarının değerlendirilmesi”. Turkish Journal of Clinics and Laboratory, vol. 8, no. 4, 2017, pp. 191-7, doi:10.18663/tjcl.354248.
Vancouver Ertürk A, Karaman İ, Karaman A, Yılmaz E, Afşarlar ÇE, Erdoğan D, Çavuşoğlu YH, Balcı Ö, Özgüner İF. Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi. TJCL. 2017;8(4):191-7.


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