[Extended, combined, and concurrent surgery in patients with neoplastic obturation large bowel obstruction]

The study included 552 patients (mean age 68.9 +/- 1.0 years) with neoplastic obturation large bowel obstruction (NOLBO). They were allocated to 3 groups depending on the character of surgical intervention. Group 1 comprised 172 patients (31.2%) operated under endotracheal anesthesia (ETA) through a medial approach for the resection of the segmented intestine and its tumours with colostomy or ileostomy (n = 154) and primary interintestinal anastomoses (n = 18). Group 2 of 56 patients (10.1%) with neglected NOLBO in very severe condition underwent medial laparotomy under ETA with internal or external colonic decompression without tumour resection. Minimally invasive decompressive ileotsomy or colostomy depending on localization of the tumor was performed under local anesthesia after premedication in 324 (58.7%) patients of group 3. The grave clinical condition of the patients was due to polyorgan insufficiency (POI). Postoperative lethality in groups 1, 2, and 3 following surgery in the acute phase of NOLBO was 26.9, 39.3, and 1.8% respectively. The condition of patients of group 1 and 2 with indications for urgent extended, combined or concurrent surgery was too serious to allow for an adequate intervention; it was possible only in 7 (14.6%) of the 48 patients. Diminution of POI manifestations by restoration of segmented intestine patency by low-invasive intervention in patients of group 3 and their preoperative preparation by balanced diet during 3-4 weeks made possible extended combined surgery in all 50 patients of this group without a fatal outcome.