Systematic Review of the Clinical Efficacy of Various Terms of Non-Surgical Treatment in Patients With Acute Adhesive Intestinal Obstruction

Abstract

BACKGROUND The question of the duration and volume of conservative measures in patients with acute adhesive intestinal obstruction (AAIO) remains the subject of numerous discussions. Aim of study To evaluate the efficacy and safety of various periods of conservative therapy in patients with AAIO using a systematic review. MATERIAL AND METHODS Criteria for inclusion in the systematic review were cohort studies investigating various regimens and duration of conservative therapy in adult patients with AAIO. The search for primary sources was carried out in the CENTRAL, PubMed and eLibrary databases. The assessment of the safety of various terms of AAIO was carried out by comparing the immediate results of treatment. RESULTS The review included 19 papers with a total of 2,570 observations. At the first stage, the effectiveness of various conservative therapy regimens was evaluated by calculating the risk ratio for the success of non-surgical treatment. Taking into account the significant statistical heterogeneity of the participants, the calculation of the final risk ratio was carried out using a random effects model. The hazard ratio for nonoperative success was 1.91 (95% CI 1.2–3.1) in favor of gastrografin and 3.71 (95% CI 1.3–10.6) in favor of preoperative intestinal intubation. Taking into account the multidirectional pathogenetic action of the studied methods of conservative therapy, the obtained results suggested that the probability of success of non-surgical treatment correlates to a greater extent with the total duration of the AAIO episode than with the duration of conservative therapy, which was indirectly confirmed by constructing scattering graphs with approximation lines and calculating the coefficients determination, which amounted to 0.69 and 0.77 for the subgroups of standard therapy and undiluted gastrografin, respectively. Subsequently, the impact of different duration of an episode of AAIO on the immediate outcomes was assessed: mortality, frequency of resection interventions, complications, and total bed-day. There were no statistically significant differences in favor of early interventions (up to 48 hours) for all compared parameters; an increase in the total duration of AAIO up to 89 hours was not associated with worse results. CONCLUSION The total duration of the episode of acute adhesive intestinal obstruction, including both the pre-hospital duration and the duration of non-surgical treatment is prognostically significant. In other words, when calculating the allowable duration of conservative measures, one should proceed from the total duration of intestinal passage disturbance, which should not exceed 89 hours.

Keywords

• acute intestinal obstruction
• acute adhesive intestinal obstruction
• non-surgical treatment
• systematic review