Ileus conditions after rectal and Hartmann’s resections
Authors:
M. Bockova; F. Pazdírek; J. Hoch
Published in the journal:
Rozhl. Chir., 2023, roč. 102, č. 10, s. 395-401.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2023.102.10.395–401
Summary
Introduction. Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann’s resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications.
Methods: We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann’s resection for rectal cancer between 2017−2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus.
Results: In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors.
Conclusion: Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.
Keywords:
postoperative ileus – small bowel obstruction – abdominoperineal rectal resection – Hartmann ́s resection – dead space
Zdroje
1. Shin JY. Risk factors of early postoperative small bowel obstruction following a proctectomy for rectal cancer. J Korean Soc Coloproctol. 2011 Dec;27(6):315−321. doi: 10.3393/jksc.2011.27.6.315.
2. Zheng H, Liu Y, Chen Z, et al. Novel nomogram for predicting risk of early postoperative small bowel obstruction after right colectomy for cancer. World J Surg Oncol. 2022 Mar 10;20(1):77. doi: 10.1186/s12957-022-02489-2.
3. ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 2013;347:f5588. Published 2013 Oct 3. doi:10.1136/bmj.f5588.
4. Ong AW, Myers SR. Early postoperative small bowel obstruction: A review. Am J Surg. 2020 Mar;219(3):535−539. doi: 10.1016/j.amjsurg.2019.11.008.
5. Wang XJ, Chi P, Lin HM, et al. Risk factors for early postoperative mall bowel obstruction after elective colon cancer surgery: An observational study of 1,244 consecutive patients. Dig Surg. 2018; 35(1):49−54. doi: 10.1159/000468155.
6. Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28. doi: 10.1007/s11894-0170566-9.
7. Nakamura Y, Matsuda K, Yokoyama Set, et al. Intraoperative maneuvers may affect the development of early postoperative small bowel obstruction after laparoscopic colorectal cancer surgery: Multicenter prospective cohort study. Int J Surg. 2021 Feb;86:52−56. doi: 10.1016/j. ijsu.2021.01.007.
8. Afshari K, Chabok A, Smedh K, et al. Risk factors for small bowel obstruction after open rectal cancer resection. BMC Surg. 2021 Jan 28;21(1):63. doi: 10.1186/ s12893-021-01072-y.
9. Suwa K, Ushigome T, Ohtsu M, et al. Risk factors for early postoperative small bowel obstruction after anterior resection for rectal cancer. World J Surg. 2018 Jan;42(1):233-238. doi: 10.1007/s00268017-4152-y.
10. Yamada T, Okabayashi K, Hasegawa H, et al. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg. 2016 Apr;103(5):493−503. doi: 10.1002/ bjs.10105.
11. Eto K, Kosuge M, Ohkuma M, et al. Defunctioning ileostomy is a key risk factor for small bowel obstruction after colorectal cancer resection. Anticancer Res. 2018 Mar;38(3):1789−1795. doi: 10.21873/anticanres.12417.
12. Poon JTC, Law WL, Chu KW. Small bowel obstruction following low anterior resection: the impact of diversion ileostomy. Langenbecks Arch Surg. 2004 Aug;389(4):250−255. doi: 10.1007/ s00423-004-0467-x.
13. Lee SY, Park KJ, Ryoo SB, et al. Early postoperative small bowel obstruction is an independent risk factor for subsequent adhesive small bowel obstruction in patients undergoing open colectomy. World J Surg. 2014 Nov;38(11):3007−3014. doi: 10.1007/s00268-014-2711-z.
14. Huang X, Xiao Z, Huang Z. Rectal stump leakage: A neglected complication after Hartmann‘s procedure for colorectal cancer. Surgery 2023 Sep;174(3):502−507. doi: 10.1016/j.surg.2023.05.022.
15. Tong JWV, Lingam P, Shelat VG. Adhesive small bowel obstruction − an update. Acute Med Surg. 2020;7(1):e587. Published 2020 Nov 4. doi:10.1002/ ams2.587
16. Matěna O. Antiadhezivní prostředky v laparoskopické operativě. Prakt Gyn. 2013;17(3):237−240.
17. ten Broek RP, Bakkum EA, Laarhoven CJ, et al. Epidemiology and prevention of postsurgical adhesions revisited. Ann Surg. 2016 Jan;263(1):12−19. doi: 10.1097/SLA.0000000000001286.
18. Varoni E, Tschon M, Palazzo B, et al. Agarose gel as biomaterial or scaffold for implantation surgery: characterization, histological and histomorphometric study on soft tissue response. Connect Tissue Res. 2012;53(6):548−554. doi: 10.3109/03008207.2012.712583.
19. Alexandre N, Ribeiro J, Gärtner A, et al. Biocompatibility and hemocompatibility of polyvinyl alcohol hydrogel used for vascular grafting − in vitro and in vivo studies. J Biomed Mater Res A. 2014 Dec;102(12):4262−4275. doi: 10.1002/ jbm.a.35098.
20. Date P, Tanwar A, Ladage P, et al. Biodegradable and biocompatible agarose– poly (vinyl alcohol) hydrogel for the in vitro investigation of ibuprofen release. Chemical Papers 2020 Jun;74:1965−1978. Doi:10.1007/s11696-019-01046-8.
21. Bocková M, Pashchenko A, Stuchlíková S, et al. Low concentrated fractionalized nanofibers as suitable fillers for optimization of structural-functional parameters of dead space gel implants after rectal extirpation. Gels 2022 Mar 4;8(3):158. doi: 10.3390/gels8030158.
22. Kelly KN, Iannuzzi JC, Rickles AS, et al. Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30day complications. Surg Endosc. 2014 Jan;28(1):65−73. doi: 10.1007/s00464013-3162-6.
23. Yao S, Tanaka E, Matsui Y, et al. Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity scorematched analysis Surg Endosc. 2017 Dec;31(12):5348−5355. doi: 10.1007/ s00464-017-5615-9.
24. Sebastian-Valverde E, Poves I, Membrilla-Fernández E, et al. The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction. BMC Surg. 2019 Apr 24;19(1):40. doi: 10.1186/s12893-0190504-x.
25. ten Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24. Published 2018 Jun 19. doi:10.1186/s13017-018-0185-2
26. Arabkhazaeli M, Keltz J, Eisenberg R, et al. Study of Risk Factors for small bowel obstruction after hysterectomy. JSLS. 2020 Oct-Dec;24(4):e2020.00070. doi: 10.4293/ JSLS.2020.00070.
27. Sheyn D, Bretschneider CE, Mahajan ST, et al. Incidence and risk factors of early postoperative small bowel obstruction in patients undergoing hysterectomy for benign indications. Am J Obstet Gynecol. 2019 Mar;220(3):251.e1−251.e9. doi: 10.1016/j.ajog.2018.11.1095.
28. Xue X, Wang D, Ji Z, et al. Risk factors of postoperative ileus following laparoscopic radical cystectomy and developing a points-based risk assessment scale. Transl Androl Urol. 2021 Jun;10(6):2397−2409. doi: 10.21037/tau21-112.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2023 Číslo 10
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