Ivanchenko R. Substantiation of surgical treatment and early enteral nutrition in acute small-bowel obstruction

The dissertation is devoted to the improvement of surgical approach and application of early enteral nutrition in complex treatment of acute small bowel obstruction. Results of surgical treatment of 121 patients with acute small-bowel obstruction are presented. Nazointestinal intubation was conducted on 56 patients, microjejunostomy - on 22 patients, their combination - on 15 patients, nasogastric tube - on 28 patients. A clinical-statistical analysis of death causes of patients with this nosology is held to identify priority areas of improvement of surgical treatment approach of acute small-bowel obstruction. The choice of the surgical treatment approach, particularly to nazointestinal intubation and microjejunostomy, is based on staging of development of acute small-bowel obstruction. Method of forming of circulating of acute obstruction of small-bowel is experimentally developed. The effect of early enteral nutrition on recovery of enteral capacity of the small-bowel is studied. In the course of experiment on structural and ultrastructural level, it is proved that early enteral nutrition helps to cut by half the time required for structure recovery, involving physiological mechanisms of regeneration of epithelium crypts and villi, leading to restoration of mucosal barrier and reduction of the activity of inflammatory response. An alternative way to provide early and, if necessary, long-term enteral nutrition through microjejunostomy is developed. Individual and objective criteria for comprehensive approach to determination of removal terms of intestinal tube are created, which allows to reasonably reduce its stay in the bowel lumen from 5,3 ± 1,3 to 3,4 ± 1,2 days. Application of the developed treatment approach enabled reduction of postoperative complications by 8.8 %, mortality level by 4.5 %, length of hospital treatment by 4,8 days.