To evaluate the profile and outcome of patients who underwent surgery for POA and to identify significant risk factor.
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 8, Pages 5031-5037
AbstractAim: The aim and objective of the present study to determine the profiles and outcomes of patients who underwent surgery for POA and to identify significant risk factor.
Materials and methods: This is a retrospective study conducted in the Department of Paediatrics surgery Patna Medical College and Hospital, Patna, Bihar, India and Sushrut Child Surgery Centre, Patna, Bihar from October 2017 to April 2020. Total 100 patients, ages 0–18 years with the diagnosis of POA were included in this study. The outcomes recorded were the presence of gangrene or perforation during the surgery for postoperative adhesions, the need for intestinal resection and stoma creation during POA surgery, the length of hospital stay, and 30-day morbidity and mortality. The presence of bowel strangulation, need for resection, and stoma creation during POA surgery were also included as risk factors in analyzing the morbidity and mortality outcomes.
Results: The average age at the time of POA surgery was 90.7 months with the range of 1.5–228.8 months. There were 20 infants, who were less than 1 year old, 49 children with ages 1 to 12, and 31 adolescents, 13 years old and above. With reference to the ages at their index operations, the average was 76.2 months with the youngest only 4 day-old neonate and the oldest at 18 years old. There were 17 neonates, 26 infants, 38 children ages 1–12, and 19 adolescents. The most common index diagnosis was appendicitis with 32 cases which is 32% of the cases. Of the 32, 18 were reported to be ruptured. The second most common diagnosis was intussusception with 12 patients. Intussusception was the most common diagnosis for patients under 1 year old who subsequently had MBO from POA. The most common index operation was appendectomy. 13 were reported to be exploratory laparotomies with a midline incision and 16 were recorded as simple appendectomies with a right lower quadrant abdominal incision. The most common index operations Peritonitis during their index surgery was documented in 41 patients. Stoma creation was done in 24 cases. 80% of cases had their index operation in an emergency setting and only 25 operations were classified as elective. The average interval from the index operation to the POA surgery was 19.1 months. With regard to the outcomes of the POA surgeries, 57% underwent only adhesiolysis or enterolysis. However, among the 100 cases, 20 required segmental intestinal resection and 26 necessitated the creation of a stoma. It was reported that there was intestinal perfo- ration or gangrene in 20 cases at the time of the POA surgery.
Conclusion: we concluded that the timely operative intervention can prevent bowel strangulation in cases of mechanical bowel obstruction from POA.
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