Calderón-Pérez A, Yanowsky-Reyes G, Manuel-Jacobo A, Marie-Aguilar GH, Abascal-Medina CG, González-Cárcamo M, Fregoso-Zúñiga AE

Language: Spanish
References: 15
Page: 220-225
PDF size: 557.93 Kb.

ABSTRACT

Introduction. Adherences are common and inevitable consequences arising from surgery. Adherence formation is part of wound healing’s natural history process and it may occur in up to 93% of patients undergoing abdominal surgery. Admission rate ranges from 0.3% after appendectomy to 25% after an ileostomy closure or formation. The most important risk factors are: previous abdominal or pelvic surgery, abdominal wall or inguinal hernia, neoplasms, irradiations, foreign body ingestion history.
Objective. This study’s goal is to describe the incidence of intestinal obstruction secondary to postoperative adhesion in pediatric patients of the pediatric surgery unit at the Hospital Civil de Guadalajara Fray Antonio Alcalde; identifying procedures responsible for this condition, admissions and treatments.
Material and Methods. This is a retrospective, observational, census study, including patients admitted with postsurgical intestinal obstruction diagnosis during a four-year period. A total of 84 patients were embodied, 38 females and 65 males, between one and fifteen years of age. The following variables were considered: age, sex, initial diagnosis, time since the first surgery to intestinal obstruction, conservative management, duration of conservative management, surgical approach, number of surgeries, recurrences, and hospital stay. Results were analyzed using central tendency measures and they were expressed using tables and percentages.
Results. Of 4,764 hospitalized children during a four-year period, 84 had complete medical records (1.7%), 65 were males, 38 females, and age ranged from zero to fifteen years (median 6.2 years). Procedures most frequently associated to intestinal obstruction were: complicated appendicitis, gastroschisis, and intestinal malrotation. Half of the postsurgical patients (54%) were readmitted after one month, and complicated appendicitis was the most common procedure (95.1%). 95% of them were treated using conservative strategies, with 50% success, along with satisfactory evolution. 39 patients had to undergo exploratory laparotomy (36) or laparoscopy (3) to resolve the clinical condition.
Discussion. There is a 2.5% incidence among the total amount of patients admitted during the four-year period, with a male predominance. The main cause of obstruction was complicated appendicitis (76%), and gastrschisis (8.3%) in second place. We observed a higher success rate (50%) in patients treated with conservative management. The most affected age groups were: patients whose age was less than one-year and 6-year-old patients. Conservative treatment time duration among patients with successful outcome was 105 hours (4.4 days), while door-operating room time was 60 hours (2.5 days). Mean hospital stay was 8 days/patient. This is a pilot study that will enable us to manifest the situation at our department regarding postsurgical intestinal obstruction. Results may be further completed with a larger sample, more variables and details, along with a standardized working protocol.

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