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Objective: To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted nasointestinal drainage of small bowel with injection of a water-soluble contrast., Material and Methods: There were 128 patients with acute adhesive small bowel obstruction for the period from 2015 to 2018. The study included 2 groups of patients depending on therapeutic approach and duration of treatment. In the first group, conventional approach for acute adhesive small bowel obstruction was applied. Upon admission, all patients with confirmed acute adhesive small bowel obstruction underwent gastric intubation for decompression of the upper gastrointestinal tract. Barium sulfate injection followed by X-ray examination was performed to assess an effectiveness of therapy. In the second group, computed tomography was performed in addition to X-ray examination and ultrasound. Moreover, conservative treatment included deep endoscopy-assisted nasointestinal drainage and subsequent administration of a water-soluble contrast in addition to traditional approaches., Results: Therapy was effective in 99 (71.2%) patients; 39 (28.8%) ones required surgery. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast was effective in 45 (78.9%) patients. Overall mortality in traditional approach was 1.4%, postoperative mortality - 3.7%. There were no lethal outcomes in case of a new approach., Conclusion: Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast is the most effective therapeutic method for acute adhesive small bowel obstruction (78.9%). These findings can significantly improve treatment outcomes in these patients.

Objective: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO)., Material and Methods: A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups., Results: ASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group ( n =36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group ( n =30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery ( p =0.287), early and late surgery in patients with strangulation ( p =0.940), early and late surgery in patients without strangulation ( p =0.76). Patients died ( n =10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours ( n =14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, p =0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, p =0.061), bowel resection (95% CI 33.3-14.0, p =0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613)., Conclusion: Delayed surgery may be advisable in patients with ASBO and no obvious signs of strangulation due to less mortality.

Aim: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction., Material and Methods: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience., Results: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

Aim: To estimate the role of emergency laparoscopic interventions in diagnosis and treatment of acute early adhesive intestinal obstruction., Material and Methods: It is presented the results of diagnostic and curative laparoscopic interventions in 58 patients with suspected acute early adhesive intestinal obstruction after abdominal surgery. Complex clinical-instrumental, non-invasive diagnosis does not always reveal this complication in early postoperative period. Diagnostic laparoscopy was the most informative method to assess state of abdominal cavity, to establish and characterize acute early adhesive intestinal obstruction, to determine following treatment and choice of surgery in all patients., Results: Diagnosis of intestinal obstruction was not confirmed in 15 (25.9%) patients based laparoscopic checkup. Acute early adhesive intestinal obstruction was established in 43 (74.1%) patients. Small intestine injuries were observed in 2 (4.5%) cases during laparoscopy. Contraindications to laparoscopic treatment of obstruction were determined in 18 (41.9%) patients in whom conventional operations were performed with complications and death in 7 (38.8%) and 3 (16.6%) cases respectively. Curative laparoscopy was applied in 23 (53.4%) patients with successful resolving of intestinal obstruction and complications in 19 (82.7%) and 4 (17.4%) cases respectively.

The success of all vascular interventions depends mainly on the chosen strategy and access, especially in patients with severe co-morbidities, preceding operations or infection. In these cases the combination of retroperitoneal approach and extra-anatomical bypasses makes the revascularization possible. We present a clinical case of a patient after radiotherapy, peritonitis and colostomy with persistent pain in the lower extremities and angiographic finding of bilateral occlusion in the aorto-iliac segment. We did a right retroperitoneal aorto-femoral reconstruction and a crossover femoro-femoral bypass. It is also possible to perform visceral and renal arterial reconstructions with the retroperitoneal approach. In addition, symptomatic and ruptured aneurysms, as well as infected aortic grafts can be operated on with optimal results, without a notable increase in mortality.

75 patients with postoperative peritoneal adhesions, complicated by a severe pain syndrome, were operated on during 2003-2006 yy. The preoperative use of the enzyme medication <> in 28 patients allowed therefore the conduction of adequate laparoscopic adhesiolysis. There were no complications and recurrences registered at follow-up. The postoperative hospital stay averaged 3.7 days.

Experience of treatment of 162 patients with acute adhesive intestinal obstruction (AAIO) is described. These patients had most often (23.3%) appendectomy in anamnesis. Conservative treatment was effective in 23 (14.2%) patients only. Surgical treatment was performed in 139 (85.8%) patients including traditional open operation in 79 (56.8%) patients, laparoscopic and laparoscopy-assisted in 60 (43.2%). Advanced adhesive process with formation of single intestinal conglomerate, neglected forms of AAIO with paralytic ileus were indications to open operations; lethality in these operations was 17.7%. Laparoscopic operation was indicated in AAIO due to isolated commissure as well as in early adhesive obstruction; lethality was 1.7%. If diagnostic laparoscopy showed that AAIO is caused by intestinal deformation in small intestinal conglomerate or intestinal resection is required, laparoscopy-assisted operations were performed.

Over a three-year period (1990-1993), a total of 410 diagnostic laparoscopies are performed. The series includes female patients with a minimum one year longstanding of sterility. Diagnostic laparoscopy is taken to be a routine method of making exact diagnosis in female sterility cases, and as a filtering procedure in forthcoming reconstructive operation or in the event of poor outlooks of eventual conception. The commonest finding is endometriosis (in 58.2 per cent), next ranking adhesions free of endometriosis (31.4 per cent) and bilateral obstruction of the uterine tubes (38.5 per cent). Endometriosis is usually located in the uterine body 27.5 per cent, uterine tubes 26.1 per cent and pelvic peritoneum 14.9 per cent.

Therapeutic and diagnostic laparoscopy was performed in 48 patients with chronic abdominal pain due to an adhesive process in the abdominal cavity. Laparoscopic treatment was applied only in patients who experienced pain when the adhesions were pulled with instruments. The adhesions were divided, the vessels were coagulated, and the organs were separated from the adhesions with instruments introduced into the abdominal cavity through additional punctures made in the anterior abdominal wall. The immediate results of the treatment were good in 44 out of 48 patients (91.6%). The late-term results were studied in 46 patients in follow-up periods of 12 months to 6 years. Recurrences were found in only 4 cases. Complications requiring special treatment were not encountered. Therapeutic and operative endoscopy is an effective and safe method for treating patients with adhesive disease manifested by abdominal pain.

The article discusses the results of small intestine splinting in various modifications with the use of a standard and specially designed silicon catheter. In the period between 1985 and 1990 operations were performed on 28 patients whose ages ranged from 16 to 81 years; all of them were operated on in a state of acute obstruction of the small intestine by adhesions, no fatal outcomes occurred. Various combinations of interventions were accomplished in 5 cases. The splinting catheter had to be removed prematurely in 2 cases because of stoma suppuration; one patient was operated on again 12 months after splinting, a doubtful result was noted in another 3 cases. In the early period the splinting catheter ensures adequate decompression of the intestine and effective prevention of postoperative paresis. The method for fixation of the standard splinting catheter is chosen individually depending on the concrete intraoperative situation. A special catheter with an inflatable cuff can be used which allows splinting of the small intestine without opening its lumen.

The work analyses the results of examination and treatment of 273 patients, aged from 18 to 74 years, with ileus caused by adhesions (AI). There were 159 males and 113 females. The diagnosis of AI was based on the findings of clinicoradiological, ultrasonic, and endoscopic examination. Early AI was recognized in 61 and delayed AI in 212 patients. Nonoperative therapy was effective in 53 patients. Operation was performed on 220 patients. Twenty-one patients underwent emergency operations due to peritonitis, urgent surgery was performed in 163 patients with unsuccessful complex nonoperative treatment and growth of clinical manifestations of AI, 36 patients were managed by planned operations after adequate examination and preoperative treatment. Obstruction of the small intestine was found in all patients: dynamic in 60, strangulation in 111, obturation in 66, and recurrent in 36 patients. Cutting of the adhesions was the operation of choice, it was performed in 178 patients. Nobles' intestinoplication was conducted in 24 and resection of the small intestine in 15 patients. A bypass anastomosis was formed in 3 patients. Postoperative complications occurred in 18 patients, 10 had to be reoperated on. Twenty-one (9.5%) patients died after surgery; 8 after emergency operations and 13 patients after urgent operations. Death was caused by intoxication (7), peritonitis consequent upon failure of the anastomosis sutures (5) hepatic failure (3), acute cardiovascular failure (3), thromboembolism of the pulmonary artery (2), and stroke (1).

The expediency of using a new radiocontrast "contrast label" method of examination was studied in 82 patients with suspected ileus caused by adhesions. The method is based on ascertaining the joining of the contrast labels at the site of the obstruction after their oral administration at an interval of one hour. The method is substantiated and described, and the indications are clearly formulated, the main one is suspected ileus. It is shown that the "contrast label" method is simple in techniques, informative, and has some advantages over X-ray examination with the prescription of a barium meal.

The work analyses 455 patients with acute adhesive intestinal obstruction (194 children with the early and 261 with the advanced stage of the disease). The most common causes of the obstruction were acute appendicitis, developmental anomalies of the intestine, and intestinal intussusception. Complete viscerolysis and horizontal intestinoplication by means of medical glue without application of sutures were performed in a total adhesion process, even in the acute period (34 cases). Severe paresis or paralysis of the gastrointestinal tract is an indication for its decompression. Laparoscopy was conducted in 90 children (from 3 months to 14 years of age) in suspected acute adhesive intestinal obstruction. The diagnosis was confirmed or defined more exactly in 64 patients. As the result of endoscopic operations intestinal obstruction was corrected and laparotomy was avoided in almost half of the patients. The total mortality was 1.3%.