Thesis for obtaining the scientific degree of a candidate of medical sciences on specialty 14.01.03 – Surgery (222 – Medicine). Kharkiv Medical Academy of Postgraduate Education of Health of Ukraine, Kharkiv, 2021.
Based on the analysis treatment results of 132 patients aged 26 to 88 years, who have been operated with reference to adhesive small bowel obstruction, we developed scientific and theoretical elements, which allowed summarizing and identifying new methods to resolve the problem of surgical treatment of patients in this category. The indications and consistency to the realization of the apparatus examination methods are specified. It has been established that diagnostic laparoscopy is the most informative diagnostic method and it must occur after the ultrasound examination (USE) and defining of "acoustic adhesions free area", and then it can be transformed into medical tactics if necessary. The diagnostic and medical algorithm for adhesive intestinal obstruction was developed, which consisted of the following: after traditional clinical and laboratory methods of examination, USE and x-ray of the abdominal cavity and confirmation of the diagnosis of AAIO, the patient was required surgery depending on the disease adhesion process.
Having compared the study results of the acetylation phenotype with the data of intraoperative finds, we have determined that the sensitivity of the test was 95.2%. This type of study allowed to correct the surgical tactics of preparation for staged adhesiolysis and to prescribe the anti-adhesive medicines. It has been proven that the fast type of acetylation is an indication for the staged laparoscopic adhesiolysis with the use of anti-adhesion medicines.
A comparative analysis of the results of complex patients treatment with adhesive intestinal obstruction was undertaken using the developed diagnostical and mwdical algorithm. It was established that the developed methodology allows to determine the individual prevention methods and to reduce the deterioration and mortality rate after surgery, as well as to improve the quality of life of operated patients. The implementation of a differentiated approach to the treatment of AAIO allowed to reduce the percentage of early postoperative complications from 35,7% to 11,4%, postoperative mortality by 3,1 times, and the hospital stay term from 16,2 to 10,0 days.
Keywords: adhesive peritoneal disease, acute adhesive intestinal obstruction, surgical tactics, laparoscopic viscerolysis, endoscopic intubation, prevention of complications.
