Small Bowel Obstruction, Small Bowel Adhesion, Strangulation of Ileum
Conditions
Keywords
conservative treatment, laparoscopic adhesiolysis, strangulation
Brief summary
This study will compare the results of early surgery after 12 h conservative treatment and 48 h conservative treatment of adhesive small bowel obstruction.
Detailed description
At the admission patients undergo abdomen x-ray, general and biochemical blood test and computer tomography (CT). After exclusion of indications for an emergency operation, patients are given a water-soluble contrast. Conservative treatment is carring out to 12 hours from admission. All patients with resolution of small bowel obstruction in 12 hours will be excluded from the research. Criteria for obstruction release of conservative treatment 1. No pain 2. Appearance of gas in the colon 3. Decrease of bloating 4. Contrast in the colon. After that, if obstruction is not resolved, randomization is performed. First group undergo surgery. Second group undergo conservative treatment with water-soluble contrast evaluation until 48 hours. In the second group surgery is performed if the conservative treatment is not effective. The results of early and late surgery and the results of conservative treatment in groups will be compared.
Interventions
PROCEDUREAdhesiolysis
Method of video laparoscopic operation: * Open access in the left upper quadrant of the anterior abdominal wall, * Installation of trocars, depending on the prevalence of the adhesion process * Assessment of the peritoneal adhesion index * Detection of the asleep gut * Detection of obstacle area * Removing the obstacle without trying to completely eliminate the adhesion process in the abdominal cavity If there is no possibility to eliminate the cause of intestinal obstruction laparoscopically laparotomy is performed.
RADIATIONX-ray diagnostics
X-ray of the thoracic (1) and abdomen (2-5 times) with water soluble contrast.
RADIATIONComputer tomography
Computer tomography of abdomen with iv contrast
PROCEDUREUltrasound
Ultrasound of the abdomen (2 times)
OTHERGeneral and biochemical blood test
General blood test and biochemical blood test 2 times a day
Sponsors
Pirogov Russian National Research Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
17 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Patients with adhesive small bowel obstruction
Exclusion criteria
Early postoperative small bowel obstruction Irreducible hernia Strangulation or peritonitis symptoms Impairment of consciousness Unstable hemodynamics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quantity of patients with obstruction release after conservative treatment | in the 2nd group - 48 hours | No of patients with success of conservative treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Readmission rate in conservative treatment and surgery | 12 months | 12 months readmission rate |
| 30 days mortality | 30 days | Number of patients who has dead in 30 days after admission |
| Complications rate | 30 days | Number of complications rate in groups |
| Quantity of bowel resection | 156 hours | Number of patients who undergo bowel resection in groups |
Countries
Russia
Contacts
Primary ContactAlexander E Tyagunov, MD. Prof
Backup ContactAlexander V Sazhin, PhD
Outcome results
None listed