Surgical management in intestinal resection with implementation of primary or delayed anastomosis for necrosis, perforation or damage of the small intestine complicated by peritonitis

Abstract

Objective. The treatment of necrosis, perforation and traumatic damage to the small intestine has always attracted the attention of surgeons due to the high incidence of complications and mortality that occur during treatment. However, there is very little research on this paper.Purpose of the study: to compare the results of treatment of patients using the tactics of suturing wounds or perforations and resection of the intestine with the imposition of a primary anastomosis with obstructive resection of the intestine with the formation of an anastomosis in a delayed manner.Material and methods. The clinical study was conducted at Novokuznetsk City Clinical Hospital No. 1 named after G.P. Kurbatov and Novokuznetsk City Clinical Hospital No. 29 named after A.A. Lutsik in the period of January 2011 to February 2019. A retrospective and prospective study was conducted, including an analysis of 835 patients treated for necrosis, perforation and traumatic damage to the small intestine. All patients were randomly distributed into groups with the imposition of a primary anastomosis and bowel resection with the formation of a delayed anastomosis. The estimated indicators were lethality and developed complications associated with the chosen treatment tactics during the patient's stay in the hospital.The results. The most common cause of surgical interventions on the small intestine was acute intestinal obstruction – 58.0%, followed by acute mesenteric circulation disorder (27.1%), inflammatory bowel perforation (6.7%) and intestinal trauma (8.3%): and the most common operation in the retrospective group was resection of the intestine with the imposition of a primary anastomosis (64.0%), then suturing of the perforations of the inte stine (5.5%) and the imposition of a stoma (4.3%), in the prospective group group anastomosis after resection of the affected area was applied in a delayed order (100%). The most common complication in the retrospective group was anastomosis or bowel suture failure (64.3%), which was only 8% in the prospective group, however, in the latter group, superficial wound infection was most common (26.8%), accompanied by wound suture dehiscence. in 11.3% of individuals. The incidence of anastomotic leaks significantly decreased after delayed formation. Intestinal fistulas/stoma leaks were detected in 11.5% of patients in the retrospective group. Patients in the prospective group had a longer median ICU stay (11 days vs 4; p < 0.001) and a longer median hospital stay (27 vs 14 days; p < 0.008). Overall mortality in the retrospective group was 47.1%, in the prospective group – 14.8%.Conclusion. Patients in the group with bowel resection and delayed anastomosis had a significantly lower rate of mortality and complications associated with anastomosis or bowel suture failure in conditions of peritonitis compared with the group with primary anastomosis, but had a longer stay in the hospital and a greater number of surgical operations.