Comprehensive application value of laparoscopic surgery combined with sodium hyaluronate in adhesive intestinal ileus / 中国生化药物杂志

Objective To observe the efficacy of laparoscopic surgery combined with sodium hyaluronate in the treatment of adhesive intestinal obstruction and its influence on disease-related indexes.Methods 180 cases of patients with adhesive ileus from September 2010 to April 2014 were selected and randomly divided into control group and observation group two groups, 90 cases in each group.The control group was treated with laparotomy and the observation group was treated by laparoscopic surgery combined with sodium hyaluronate.Then the operation related indexes such as operation time, intraoperative bleeding volume, postoperative gastrointestinal function recovery time, hospitalization time and complications of two groups were compared.And the serum levels of gastrointestinal hormone such as GAS, MTL, CCK and SS and inflammatory cytokines such as hs-CRP, IL-2, IL-6, IL-10 and TNF-αof two groups before and after treatment were detected and compared.Results The intraoperative bleeding volume of observation group was less than control group, postoperative gastrointestinal function recovery time and hospitalization time were shorter than control group, the incidence of complications was lower than control group, the difference was statistically significant (P <0.05).1, 4 weeks postoperative, the serum levels of gastrointestinal hormone such as GAS, MTL and SS of observation group were higher than control group, while the CCK was lower than control group, the difference was statistically significant (P<0.05).1, 4 weeks postoperative, the serum levels of inflammatory cytokines such as hs-CRP, IL-2, IL-6 and TNF-αof observation group were lower than control group, the difference was statistically significant (P<0.05).Conclusion Compared with the traditional laparotomy, laparoscopy combined with sodium hyaluronate has the advantages of small effect on patients with digestive function and postoperative inflammatory reaction, thus helps to shorten the recovery time of patients after surgery and inhibition the occurrence of complications such as recurrent intestinal obstruction.

Clinical application of laparoscopic lysis of adhesions in adhesive intestinal obstruction / 中国内镜杂志

Objective To evaluate the clinical efficacy and safety of laparoscopic adhesiolysis for patients with adhesive ileus. Methods Clinical data and follow-up data of 95 cases of adhesive ileus were retrospectively analyzed. Based on the surgical approach, patients were divided into laparotomy group (43 cases) and laparoscopic group (52 cases), and the intraoperative situation postoperative complications and recurrence were compared. Results The operation time of laparoscopy group was less than the laparotomy group [(68.35 ± 36.47) vs (82.54 ± 23.27) min, t = 2.21, P = 0.029]; blood loss was less than the laparotomy group [(69.51 ± 20.33) vs (198.37 ± 50.04) ml, t = 16.97, P = 0.000]; postoperative analgesic dosage was less than the laparotomy group [(1.01 ± 0.99) vs (3.46 ± 1.53), t = 9.41, P = 0.000]; time of posterior ambulation was less than the laparotomy group [(11.05 ± 1.32) vs (20.36 ± 2.59) d, t = 16.97, P = 0.000]; gastrointestinal function recovery time was less than laparotomy group [(2.30 ± 1.38) vs (4.05 ± 1.74) d, t = 5.47, P = 0.000]; catheter removal time was lower than the laparotomy group [(3.04 ± 2.11) vs (5.36 ± 2.24) d, t = 5.19, P = 0.000]; hospital stay was less than the laparotomy group [(5.89 ± 1.57) vs (10.36 ± 2.65) d, t = 10.02, P = 0.000]; the postoperative complication rate of laparoscopy group and laparotomy group was 3.84% (2 cases) and 16.27% (7 cases), respectively, the difference was not statistically significance (χ2 = 4.24, P = 0.074); followed up from 8 to 36 months, there were 2 cases, 6 cases of intractable abdominal pain and intestinal obstruction recurrence in laparoscopy group and laparotomy group respectively, the relapse outcomes of laparotomy group was higher than laparoscopy group, but the difference was not statistically significant (χ2 = 3.64, P = 0.056). Conclusion Laparoscopic adhesiolysis is safe, effective, and have the characteristics with less trauma, less interference on the abdominal cavity, it is better than open surgery.

A Case of Intestinal Adhesive Ileus, Successfully Treated with Daikenchuto during Pregnancy and Post Cesarean Section / 日本東洋医学雑誌

We report a clinical case of adhesive ileus that was treated with daikenchuto during pregnancy, and post cesarean section. A 29-year woman, who had undergone a laparotomy for small intestinal volvulus at the age of 15, was referred to our hospital for abdominal distention at11weeks gestation. Her severe abdominal distention led to the intestinal adhesive ileus finding. After treatment with daikenchuto, she had mass diarrhea while the abdominal symptoms disappeared. Afterwards, the prenatal course was uneventful. Spontaneous labor began at 36 weeks gestation. Under the indication of fetal distress, an emergent cesarean section was performed. There was widespread adhesion between the small intestine and abdominal wall. On post operative day 4, nausea and vomiting increased. Daikenchuto was orally administered with the diagnosis of recurrent adhesive ileus. On day 6, flatus and soft stool were passed. On day 9, oral food ingestion was begun. Her post operative course was uneventful beyond this, and she was discharged on day 25. Recently, clinical reports of adhesive ileus during pregnancy have been increasing as average maternal ages rise. Adhesive ileus during pregnancy tends to be critical for mothers and babies, so a surgical procedure is necessary in many cases. This report suggests the usefulness of daikenchuto for adhesive ileus during the perinatal period.

A Case of Adhesive Ileus Successfully Treated with Shojokito / 日本東洋医学雑誌

We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.

The Effect of Hyaluronate Membrane on Prevention of Adhesion after Rectal Cancer Surgery: a Prospective Study

PURPOSE: The aim of this study was to evaluate the efficacy of using a Hyaluronate (HA) bioresorbable membrane (SeprafilmTM, Genzyme Corp., Cambridge, MA) to prevent adhesion after rectal cancer surgery. METHODS: We recruited 362 rectal cancer patients who underwent a curative resection between April 2001 and December 2002. We excluded patients with a previous operation history, a stoma procedure, a multivisceral resection, an extended lymphadenectomy, a total colectomy, or a pouch procedure. An adhesive ileus was defined as a symptomatic, radiological intestinal obstruction without evidence of recurrence. RESULTS: We placed the HA membrane under the midline incision in 153 patients. There was no difference between the groups regarding demographic findings and clinicopathological findings, including locations of the tumors, surgery performed, AJCC stage, and adjuvant treatment. While only 1 (0.7%) patient of the HA group experienced an adhesive ileus, 13 (6.2%) cases of adhesion were identified in the control group (P=0.008). Every patient, except 1 in the control group, underwent conservative management. CONCLUSIONS: A Hyaluronate membrane may be effective in preventing an adhesive ileus after rectal cancer surgery. However, a prospective, randomized, double-blind study is needed.

Remarks on diagnosis, designation and treatment of postperative adhesive ileus of 105 cases has operated emergency at Hai Phong Viet Tiep Hospital (from 31/12/1997 - 31/12/2001)

During 4 years (31/12/1997 - 31/12/2001), the Viet Tiep Hospital has operated 105 cases with postoperative adhesive ileus, 56 males and 49 females, the youngest is 13 years old, the oldest is 83 years old, with a mean age of 42.4. Clinical - X ray signs: stomachache 100%, loss fart 100%, vomit 97.1%, 100% X quang of stomach had steam level, brilliant intestine 33.3%. The therapeutic results: mean period of hospitalization was 11.3 days, mortality 0%, the patients having the time before operation of 15 hours - 24 hours are 50.5%, of > 24 hours are 40,9%

Clinical analysis of adhesive ileus in children

The effectiveness of operative and non-operative management for postoperative adhesive ileus in children has been discussed. This study reviews the clinical characteristics and the treatment consequences of adhesive ileus in our institution, Department of Surgery of Chunbuk National University Hospital, retrospectively. A total of 62 cases of post-operative small bowel obstruction treated between January 1975 and December 1998 under the 15 years of age are included in this study. The patients were divided into two groups, operative (n=26) and non-operative (n=36) groups. The prevalent age was between 11 and 15 years (28 cases; 45.2%), and the most common previous operation was appendectomy (28 cases; 45.2%). The most common operative procedures were adhesiolysis (17 cases; 65.4%). The interval between admission and operation was 1 day in 11 cases (42.3%). The most common site of adhesion was the ileum in 13 cases (50.0%) and band constriction was the most frequent pattern (8 cases; 30.8%). Intestinal resection was significantly high in delayed operations of more than four days, in the patients with three or more classical signs of strangulation (fever, tachycardia, leukocytosis, abdominal pain, rebound tenderness), and in the cases of complete obstruction on plain abdomen film (p < 0.05). In conclusion, operation should be considered in cases with three or more signs of strangulation, no clinical improvement for over four days of conservative treatment, and signs of complete obstruction on plain abdomen film during the observation periods.

Clinical Analysis of Laparoscopic Adhesiolysis

PURPOSE: Laparoscopic management of intestinal obstruction is hypothetically attractive, However little is known about this procedure in our country. With new advances in diagnostic and therapeutic tools such as laparoscopic procedures, the management of intestinal obstruction has become feasible. METHODS: In order to analyze the clinical results of laparoscopic adhesiolysis, a retrospective review of a consecutive series of 20 cases of intestinal obstruction unresponsive to medical management was done between 1997 and 2000. RESULTS: The mean surgical time for the laparoscopic procedure was 75 min and two cases were converted to open surgery due to dense adhesion and intestinal strangulation. The characterization of adhesion type included 10 cases with simple fibrotic band, 4 cases with multiple fibrotic band and 5 cases with dense adhesion. Additionally, the most common site for adhesion was the small intestine and colon (12 cases). The mean diet start time was 2.3 days, mean hospital stay was 4.7 days and totally mean analgesic use was 1.6 times. CONCLUSION: Laparoscopic management of adhesive bowel obstruction is feasible and safe in experienced hands. The laparoscopic procedure also is an excellent diagnostic modality in case of obstruction, and the majority of these cases can be simultaneously managed laparoscopically. A laparoscopic approach is recommend as a first choice of treatment for selective cases of intestinal adhesion.