Postoperative adhesions after abdominal surgery in children: a pilot study in the Philippines

Abstract

BackgroundPostoperative adhesions (POAs) causing mechanical bowel obstruction is a challenging problem for children who underwent prior abdominal surgeries. Unlike in adults, the role of conservative management remains controversial and children tend to require re-operation. However, despite the longer lifetime risk inherent to the pediatric population, studies are still lacking to come up with guidelines on diagnosis and management. This study aimed to review the profiles and outcomes of patients who underwent surgery for POA and to identify significant risk factors.MethodsThis was a retrospective review of 172 patients admitted at the Philippine General Hospital from 2010 to 2018 with the diagnosis of POA. Patients who did not undergo surgery and patients who had a different cause of bowel obstruction with the adhesions being only incidental were excluded from the study.ResultsNinety-one patients were included in the study. The mean age at surgery was 92.32 months and the male:female ratio was 2.8:1. The most common primary diagnoses were appendicitis, intussusception, and abdominal trauma. POA occurred within the first postoperative year in 63%. The 30-day morbidity and mortality rates were 9.89% and 7.69%, respectively. The most common complications were fascial and anastomotic dehiscences, and sepsis was the most common cause of death. Stoma creation during the index operation, and the presence of bowel gangrene, intestinal resection, and stoma creation during the surgery for POA were statistically significant risk factors for morbidity and mortality.ConclusionThe findings in this study support the experience in literature that timely operative intervention can prevent bowel strangulation in cases of mechanical bowel obstruction from POA. However, more data and studies are recommended to arrive at an evidence-based guideline in the management of these children.

The Effect of Vitamin E Administration in Topical Olive Oil and Metamizole Injection on Plasminogen Activator Inhibitor-1 (PAI-1) Peritoneal Fluid and Degree of Adhesion

“…(Croes and Vanegas, 2008) In addition, the inhibition of the Cyclooxygenase (COX) enzyme causes the formation of free radicals. (Deogracias and Almonte, 2019) Research that has been done before using non-steroidal antiinflammatory drugs. Another type is ketorolac.…”

“…(Kadek Deddy Ariyanta, Dikki Drajat Kusmayadi 2020) In a study conducted in the Philippines, it was also mentioned that several diseases that can cause adhesions after laparotomy surgery are Hirschsprung's disease, malrotation, intestinal atresia, enterocolitis. (Deogracias & Almonte 2019).…”

“…As a result of the increased concentration and activity of these cytokines, PA activity will increase, while PAI activity will be inhibited. (Deogracias and Almonte, 2019) In general, the causes of adhesions are trauma, infection and tissue ischemia. The key to preventing adhesions after surgery is to selectively prevent factors that can cause adhesions.…”

“…(Kadek Deddy Ariyanta, Dikki Drajat Kusmayadi, 2020) Until now there is no standard to prevent post-laparotomy intraperitoneal adhesions in children. (Deogracias and Almonte, 2019) The most effective way is to minimize the risk of adhesions with good surgical technique, handling and dissection of delicate tissues, careful homeostasis, avoiding extensive thermal trauma, adequate irrigation, avoiding exposure to foreign bodies (such as powder gloves and nonabsorbable sutures). and infection prevention.…”

“…(Wu et al, 2021) In addition, the inhibition of the Cyclooxygenase (COX) enzyme causes the formation of free radicals. (Deogracias and Almonte, 2019) If the results of research using vitamin E in topical olive oil and metamizole are proven to be effective in inhibiting adhesion, then it can qualify as an inexpensive and easy-to-obtain anti-adhesion agent. Therefore, further research is needed whether the use of these two ingredients alone or in combination can have a potentiating effect and further enhance its anti-adhesion effect.…”