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The Volume of Intestinal Decompression can Predict the Necessity of Surgical Intervention for Adhesive Small Bowel
Jun Kono1, Koichiro Yoshimaru2, Takuya Kondo2
1Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan; Pediatric Emergency and Critical Care Center, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
Insights
Increased gastrointestinal drainage volume on day 2 may predict the need for surgery in children with adhesive small bowel obstruction (ASBO) who initially undergo conservative treatment.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Surgical outcomes
Background:
- Optimal timing for surgical intervention in pediatric adhesive small bowel obstruction (ASBO) remains unclear.
- Conservative treatment is often the initial approach for pediatric ASBO.
- Predictive markers for surgical intervention are needed.
Purpose of the Study:
- To investigate if gastrointestinal drainage volume can predict the need for surgical intervention in pediatric ASBO patients.
- To establish a potential cut-off value for drainage volume.
Main Methods:
- Retrospective review of 150 pediatric ASBO episodes (2008-2019).
- Patients divided into successful conservative treatment (CT) and eventual surgical treatment (ST) groups.
- Analysis of gastrointestinal drainage volume on day 2.
Main Results:
- Statistically significant higher drainage volume on day 2 in the ST group compared to the CT group (p < 0.01).
- Identified a cut-off drainage volume of 11.7 ml/kg for both overall and first-episode analyses.
- Results consistent across all ASBO episodes and first-episode ASBO.
Conclusions:
- Elevated gastrointestinal drainage volume on day 2 is a significant predictor of surgical intervention in pediatric ASBO.
- Drainage volume may serve as a valuable tool to guide treatment decisions in pediatric ASBO.
- This finding aids in determining the optimal timing for surgery in children with ASBO.
Background:
There is no standard timing for switching to surgical management for children with adhesive small bowel obstruction (ASBO) who initially receive conservative treatment. We hypothesized that an increased gastrointestinal drainage volume may indicate the need for surgical intervention.
Methods:
The study population included 150 episodes in the patients less than 20 years of age who received treatment for ASBO in our department from January 2008 to August 2019. Patients were divided into two groups: the successful conservative treatment group (CT) and the eventual surgical treatment group (ST). Following the analysis of all episodes (Study 1), we limited our analysis to only first ASBO episodes (Study 2). We retrospectively reviewed their medical records.
Results:
There were statistically significant differences in the volume on the 2nd day in both Study 1 (9.1 ml/kg vs. 18.7 ml/kg; p < 0.01) and study 2 (8.1 ml/kg vs. 19.7 ml/kg; p < 0.01). The cut-off value was the same for both Study 1 and Study 2 (11.7 ml/kg).
Conclusions:
The gastrointestinal drainage volume on the 2nd day in ST was significantly larger than that in CT. Accordingly, we considered that the drainage volume may predict eventual surgical intervention for children with ASBO who initially receive conservative treatment.
Level Of Evidence:
Level IV.
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