Nasointestinal tubes versus nasogastric tubes in the management of small-bowel obstruction

Dong, Xianwen; Huang, S.Q.; Jiang, Zhou-Hua; Yu-Fei, Song

doi:10.1097/md.0000000000012175

Cited by 13 publications

(3 citation statements)

References 16 publications

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“…Patients with signs of strangulation or peritonitis (fever, tachycardia and leukocytosis, metabolic acidosis, and continuous abdominal pain) are absolutely not candidates for conservative treatment. Conversely, up to 70% of non-complicated ASBO can be resolved by conservative treatment with gastrointestinal (GI) decompression with nasogastric or nasointestinal tubes (no significant difference currently exists between nasogastric and nasointestinal tubes in terms of ASBO resolution), intravenous fluid, analgesics, correction of electrolyte imbalance, and a regular clinical and imaging reassessment (45).…”

Section: When To Operate On Asbo Patients?mentioning

confidence: 99%

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021

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Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

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Section: When To Operate On Asbo Patients?mentioning

confidence: 99%

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021

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“…После санации брюшной полости определяются показания к дренированию тонкой кишки, которое выполняется чаще всего при выраженных признаках паралитической непроходимости кишечника. Выявление во время операций дилятированных более 3.0 см петель тонкой кишки с массивными фибринозыми наложениями и субсерозными кровоизлияниями принято считать основанием для ее дренирования [27]. С другой стороны, травматичность данной манипуляции в условиях повышенной ранимости серозных оболочек на фоне отека и многочисленные осложнения, ассоциированные с назоинтестинальной интубацией, заставляют задуматься о целесообразности этой манипуляции.…”

Section: хирургическое лечение третичного перитонитаunclassified

Surgical Treatment of Patients With Tertiary Peritonitis

Земляной¹,

Сигуа²,

Петров³

et al. 2019

Novosti Khirurgii

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Северо-западный государственный медицинский университет им. И.И. Мечникова 1 , Городская больница Святой преподобномученицы Елизаветы 2 , г. Санкт-Петербург, Российская Федерация Проблемам лечения третичного перитонита посвящено большое количество научных работ, затрагивающих самые разные аспекты этого заболевания. Анализ литературы демонстрирует тенденцию к росту частоты персистирующих перитонитов среди пациентов хирургических стационаров и отсутствие единых подходов к его лечению. Диагностические критерии третичного перитонита крайне неспецифичны, что затрудняет построение эффективной лечебной программы. В данной статье основное внимание уделено вопросам адекватной санации брюшной полости как одному из основных лечебных компонентов. Применение плановых и релапаротомий «по требованию» внедрено в клиническую практику давно, однако четких показаний к применению конкретной оперативной тактики в доступной литературе обнаружено не было. Дана сравнительная оценка различным способам ведения брюшной полости (открытому, закрытому, полуоткрытому, полузакрытому). Рассмотрены основные пути минимизации операционной травмы, неизбежно сопутствующей многократным хирургическим вмешательствам и приводящей к развитию осложнений со стороны органов брюшной полости и передней брюшной стенки. Проблема третичного перитонита, безусловно, далека от своего окончательного решения и дальнейший научный поиск, направленный на совершенствование хирургических подходов, должен способствовать улучшению ближайших результатов лечения.Ключевые слова: третичный перитонит, санация, брюшная полостьThe problems of tertiary peritonitis treating are described in a large amount of scientific papers covering various aspects of this disease. The analysis of the literature shows an increased frequency of persistent peritonitis among patients of surgical units and the lack of unified approaches to its treatment. The diagnostic criteria of tertiary peritonitis are extremely non-specific, which makes it difficult to work out an effective treatment program. This article focuses on adequate sanitation of the abdominal cavity as one of the main therapeutic components. The use of planned and "on demand" relaparotomies was introduced into clinical practice long ago, however, no clear indications for the use of specific operational tactics were found in the available literature. A comparative assessment is given to different ways of abdominal cavity managing (open, closed, half-open, half-closed). The main ways of operative injury minimizing, that inevitably accompanies repeated surgical interventions and leads to the development of abdominal complication, are considered. Obviously, the problem of tertiary peritonitis is far from its final decision, and further scientific research aimed at surgical approaches upgrade should help to improve the results of treatment.

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“…Основными эффектами НИИ являются удаление токсического содержимого из просвета тонкой кишки, снижение внутрибрюшного и внутрикишечного давления, улучшение микроциркуляции в органах брюшной полости, профилактика САК, что создает условия для закрытия брюшной полости без натяжения передней брюшной стенки [16]. Однако проведенные исследования и метаанализы данных зарубежной литературы по сравнению эффективности НИИ с обычным назогастральным зондом существенных различий не выявили [17]. Кроме того, критическое отношение к НИИ связано с трудностью выполнения, травматичностью манипуляции, а также частыми осложнениями [15,18].…”

Section: Introductionunclassified

Effect of Different Methods of Abdominal Decompression on the Dynamics of Intra-Abdominal Pressure in the Early Postoperative Period in Patients with Secondary Diffuse Peritonitis: Observational Study

Popandopulo,

Isakhanian,

Bazlov

et al. 2023

Kuban. nauсh. med. vestnik

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Background. Intra-abdominal hypertension complicates the course of secondary diffuse peritonitis in at least 60–70% of cases. Abdominal decompression is an essential component in the complex of therapeutic measures in patients with secondary diffuse peritonitis. However, no clear criteria for choosing the method and timing of abdominal decompression have been developed so far. The effectiveness of its use in various forms of peritonitis remains controversial.Objectives — to study the dynamics of intra-abdominal pressure in the early postoperative period when using various methods of abdominal decompression in patients with secondary diffuse peritonitis.Methods. The work was performed on the basis of an observational clinical study under the auspices of Regional Clinical Emergency Hospital over a period from January 2021 to December 2022. The authors studied intra-abdominal pressure in 74 patients with secondary diffuse peritonitis in the early postoperative period. In 39 (52.7%) patients (group 1), decompression was carried out in the form of prolonged nasogastric intubation. 15 (20.3%) patients (group 2) underwent nasointestinal intubation. Group 3 was represented by 10 patients (13.5%) which were affected by open abdomen technology and vacuum assisted closure (VAC). Group 4 included patients with vacuum-assisted laparostoma who underwent nasointestinal intubation. The severity of peritonitis was assessed using WSES cIAIs Score and Mannheim Peritonitis Index. The dynamics of intra-abdominal pressure was determined through the urinary catheter using the Uno Meter Abdo Pressure® Kit (Unomedical, Russia) before surgery and within 5 days of the postoperative period. Statistical analysis was based on non-parametric Wilcoxon test for comparing the values of the same group at different periods of observation. Mann-Whitney U-test was used to compare absolute values in different groups.Results. Nasogastric tube did not provide an acceptable reduction in intra-abdominal pressure, especially in patients with severe forms of peritonitis. Prolonged nasointestinal intubation contributed to a steady decrease in intra-abdominal pressure throughout the postoperative period, while simultaneous intubation resulted in an increase in intra-abdominal hypertension after a decline in values one day after surgery. The best results of intra-abdominal pressure dynamics were observed in case of vacuum-assisted laparostomy and its combination with nasointestinal intubation. Throughout the postoperative period, the intra-abdominal pressure did not exceed 15–17 mmHg. This method can be used only in treatment of the most severe forms of peritonitis, with indications for sanitation relaparotomy and in case of threatened abdominal compression syndrome.Conclusion. The data obtained enable the process of choosing surgical tactics and method of abdominal decompression to be optimized with respect to the severity of peritonitis and intra-abdominal hypertension.

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Nasointestinal tubes versus nasogastric tubes in the management of small-bowel obstruction

Cited by 13 publications

References 16 publications

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

Surgical Treatment of Patients With Tertiary Peritonitis

Effect of Different Methods of Abdominal Decompression on the Dynamics of Intra-Abdominal Pressure in the Early Postoperative Period in Patients with Secondary Diffuse Peritonitis: Observational Study

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