- Laparoscopy in the treatment of children with adhesive bowel obstruction
Laparoscopy in the treatment of children with adhesive bowel obstruction
PAEDIATRIC SURGERY.UKRAINE.2018.2(59):46-50; DOI 10.15574/PS.2018.59.46
Pereyaslov A. A., Dvorakevych A. O., Nykyforuk O. M.
Danylo Halytsky Lviv National Medical University, Ukraine
CI Lviv Oblast Children’s Clinical Hospital «OKHMATDYT», Ukraine
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.
Key words: postoperative adhesive bowel obstruction, children, laparoscopy.
1. Aguayo P, Fraser JD, Ilyas S et al. (2011). Laparoscopic management of small bowel obstruction in children. J Laparoendosc Adv Surg Tech A. 21: 85-88. https://doi.org/10.1089/lap.2010.0165.
2. Ahmad G, Gent D, Henderson D et al. (2015). Laparoscopic entry techniques. Cochrane Database Syst Rev. CD006583. https://doi.org/10.1002/14651858.CD006583.pub4.
3. Alemayehu H, David B, Desai AA et al. (2015). Laparoscopy for small bowel obstruction in children – an update. J Laparoendosc Adv Surg Tech A. 25: 73-76. https://doi.org/10.1089/lap.2014.0228.
4. Anderson SA, Beierle EA, Chen MK. (2014). Role of laparoscopy in the prevention and in the treatment of adhesions. Semin Pediatr Surg. 23: 353-356. https://doi.org/10.1053/j.sempedsurg.2014.06.007.
5. Apelt N, Featherstone N, Giuliani S. (2013). Laparoscopic treatment for adhesive small bowel obstruction: is it the gold standard in children too? Surg Endosc. 27: 3927-3928. https://doi.org/10.1007/s00464-013-2891-x.
6. Brokelman WJ, Holmdahl L, Bergstrom M et al. (2006). Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: A randomized trial. J Surg Res. 136: 309-313. https://doi.org/10.1016/j.jss.2006.07.044; PMid:17054995
7. Byrne J, Saleh F, Ambrosini L et al. (2015). Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc. 29: 2525-2532. https://doi.org/10.1007/s00464-014-4015-7.
8. Catena F, Di Saverio S, Coccolini F et al. (2016). Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention. World J Gastrointest Surg. 8: 222-231. https://doi.org/10.4240/wjgs.v8.i3.222.
9. Dindo D, Schafer M, Muller MK et al. (2010). Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc. 24: 792-797. https://doi.org/10.1007/s00464-009-0658-1.
10. Eeson GA, Wales P, Murphy JJ. (2010). Adhesive small bowel obstruction in children: should we still operate? J Pediatr Surg. 45: 969-974. https://doi.org/10.1016/j.jpedsurg.2010.02.030.
11. Goussous N, Kemp KM, Bannon MP et al. (2015). Early postoperative small bowel obstruction: open vs laparoscopic. Am J Surg. 209: 385-390. https://doi.org/10.1016/j.amjsurg.2014.07.012.
12. Grafen FC, Neuhaus V, Schob O et al (2010). Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg. 395: 57-63. https://doi.org/10.1007/s00423-009-0490-z.
13. Grant HW, Parker MC, Wilson MS et al. (2006). Population-based analysis of the risk of adhesion-related readmissions after abdominal surgery in children. J Pediatr Surg. 41: 1453-1456. https://doi.org/10.1016/j.jpedsurg.2006.04.023.
14. Grant HW, Parker MC, Wilson MS et al. (2008). Adhesions after abdominal surgery in children. J Pediatr Surg. 43: 152-157. https://doi.org/10.1016/j.jpedsurg.2007.09.038.
15. Kelly KN, Iannuzzi JC, Rickles AS et al. (2014). Laparotomy for smallbowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc. 28: 65-73. https://doi.org/10.1007/s00464-013-3162-6.
16. Khaikin M, Schneidereit N, Cera S et al. (2007). Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc. 21: 742-746. https://doi.org/10.1007/s00464-007-9212-1.
17. Lakshminarayanan B, Hughes-Thomas AO, Grant HW. (2014). Epidemiology of adhesions in infants and children following open surgery. Semin Pediart Surg. 23: 344-348. https://doi.org/10.1053/j.sempedsurg.2014.06.005.
18. Lautz TB, Barsness KA. (2014). Adhesive small bowel obstruction – acute management and treatment in children. Semin Pediart Surg. 23: 349-352. https://doi.org/10.1053/j.sempedsurg.2014.06.006.
19. Lee J, Tashjian DB, Moriarty KP (2012). Surgical management of pediatric adhesive bowel obstruction. J Laparoendosc Adv Surg Tech A. 22: 917-920. https://doi.org/10.1089/lap.2012.0069.
20. Loftus T, Moore F, Van Zant E et al. (2015). A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg. 78: 13-21. https://doi.org/10.1097/TA.0000000000000491.
21. Maung AA, Johnson DC, Piper GL et al. (2012). Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 73; Sup 4: 362-369. https://doi.org/10.1097/TA.0b013e31827019de.
22. Menzies D, Ellis H. (1990). Intestinal obstruction from adhesions how big is the problem? Ann R Coll Surg Eng. 72: 60-63. PMid:2301905 PMCid:PMC2499092
23. Miyake H, Seo S, Pierro A. (2018). Laparoscopy or laparotomy for adhesive bowel obstruction in children: a systematic review and meta-analysis. Pediatr Surg Int. 34(2): 177-182. https://doi.org/10.1007/s00383-017-4186-0.
24. Molinaro F, Kaselas C, Lacreuse I et al. (2009). Postoperative intestinal obstruction after laparoscopic versus open surgery in the pediatric population: A 15‐year review. Eur J Pediatr Surg. 19: 160-162. https://doi.org/10.1055/s-0029-1202858.
25. Murphy FL, Sparnon AL. (2006). Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review. Pediatr Surg Int. 22: 326-329. https://doi.org/10.1007/s00383-006-1653-4.
26. Okamoto H, Wakana H, Kawashima K et al. (2012). Clinical outcomes of laparoscopic adhesiolysis for mechanical small bowel obstruction. Asian J Endosc Surg. 5: 53-58. https://doi.org/10.1111/j.1758-5910.2011.00117.x.
27. Pei KY, Asuzu D, Davis KA. (2017). Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database Surg. Endosc. 31: 2180-2186. https://doi.org/10.1007/s00464-016-5216-z.
28. Sauerland S, Agresta F, Bergamaschi R et al. (2006). Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc. 20: 14-29. https://doi.org/10.1007/s00464-005-0564-0.
29. Strickland P, Lourie DJ, Suddleson EA et al. (1999). Is laparoscopy safe and effective for treatment of acute small-bowel obstructions? Surg Endosc.13: 695-698. https://doi.org/10.1007/s004649901075.
30. Szomstein S, Menzo EL, Simpfendorfer C et al. (2006). Laparoscopic lysis of adhesions. World J Surg. 30: 535-540. https://doi.org/10.1007/s00268-005-7778-0.
31. Tierris I, Mavrantonis C, Stratoulias C et al. (2011). Laparoscopy for acute small bowel obstruction: indication or contraindication? Surg Endosc. 25: 531-535. https://doi.org/10.1007/s00464-010-1206-8.
32. van Eijck FC, Wijnen RM, van Goor H. (2008). The incidence and morbidity of adhesions after treatment of neonates with gastroschisis and omphalocele: a 30-year review. J Pediatr Surg. 43: 479-483. https://doi.org/10.1016/j.jpedsurg.2007.10.027.
33. Vettoretto N, Carrara A, Corradi A et al. (2012). Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis. 14: 208-215. https://doi.org/10.1111/j.1463-1318.2012.02968.x.