Comparative Effectiveness of Early and Delayed Surgical Interventions in Patients with Acute Adhesive Intestinal Obstruction: A Multicenter Controlled Randomized Trial Prospective Study
B. V. Sigua,
A. E. Demko,
S. V. Petrov,
P. A. Kotkov,
I. A. Soloviev,
A. V. Vovk,
A. V. Osipov,
V. I. Serdyuk,
D. A. Chernyshev,
M. A. Protchenkov,
I. I. Gubkov,
M. G. Zaitsev,
S. Yu. Puzanov,
A. A. Kozobin,
O. V. Babkov,
A. V. Glebova,
D. S. Sakhno,
D. V. Gurzhiy,
V. P. Zemlyanoy https://doi.org/10.23934/2223-9022-2025-14-1-69-80
Abstract
Acute adhesive intestinal obstruction (AAIO) is one of the most common pathological conditions, making a significant contribution to the spectrum of urgent surgical diseases. Treatment of such patients consists of conservative therapy and surgical treatment, the indications for which vary within the domestic and foreign recommendations. Existing works in the format of observational cohort studies devoted to the comparative efficacy and safety of various terms of non-surgical treatment of AAIO indicate in favor of long terms of conservative therapy, contributing to an increase in its afficacy without a negative impact on the outcomes of operated patients. However, these studies contain a number of features that limit their external validity, due to which conducting a study in a randomized format seemed justified.
AIM OF THE STUDY. Evaluation of the efficacy and safety of extending the duration of non-surgical treatment of patients with AAIO.
RESEARCH MATERIALS. For the study, 216 patients with AAIO were selected, who, in accordance with the chosen randomization method, were distributed into the main (117 patients) and comparison groups (99 patients). During the implementation of the algorithm of actions, it was possible to achieve non-surgical resolution of AAIO phenomena in 86 patients (73.5%) of the main group, which, although statistically insignificant, exceeded the similar indicator of the comparison group, where successful conservative measures were carried out in 61 patients (61.6%) (χ2=3.48, p=0.06). Such results were probably achieved due to the longer duration of inpatient conservative treatment, which in the main group was 47.1±32.4 versus 16.8±14.2 hours in the comparison group (p<0.001). Comparison of the frequency of resection interventions, postoperative complications and average bed-day did not demonstrate statistically significant differences in all compared parameters.
CONCLUSION. The extension of the duration of conservative therapy from 16.8±14.2 to 47.1±32.4 hours demonstrated a positive trend of increasing the frequency of non-surgical resolution of acute adhesive intestinal obstruction without a negative impact on the immediate outcomes of operated patients.
About the Authors
B. V. Sigua
V.A. Almazov National Medical Research Center
Russian Federation
Russian Federation
Badri V. Sigua - Doctor of Medical Sciences, Professor, Head of the Department of General Surgery, V.A. Almazov National Medical Research Center.
Akkuratova Str. 2, Saint Petersburg, 197341
A. E. Demko
Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine
Russian Federation
Russian Federation
Andrey E. Demko - Doctor of Medical Sciences, Professor, Deputy Director for Research, I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine.
Budapestskaya Str. 3, lit. A, Saint Petersburg, 192242
S. V. Petrov
I.I. Mechnikov North-West State Medical University; Elizabethan Hospital
Russian Federation
Russian Federation
Sergey V. Petrov - Doctor of Medical Sciences, Professor, Professor of the S.A. Simbirtsev Department of Operative and Clinical Surgery with Topographic Anatomy, I.I. Mechnikov North-Western State Medical University; Chief Physician, Elizabethan Hospital.
Kirochnaya Str., 41, Saint Petersburg, 191015; Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
P. A. Kotkov
V.A. Almazov National Medical Research Center; Elizabethan Hospital
Russian Federation
Russian Federation
Pavel A. Kotkov - Candidate of Medical Sciences, Assistant Professor at the Department of General Surgery, V.A. Almazov National Medical Research Center; Surgeon at the Surgical Department No. 2, Elizabethan Hospital.
Akkuratova Str. 2, Saint Petersburg, 197341; Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
I. A. Soloviev
City Mariinsky Hospital
Russian Federation
Russian Federation
Ivan A. Soloviev - Doctor of Medical Sciences, Professor, Deputy Chief Physician for Surgery, City Mariinsky Hospital.
Liteiny Ave. 56, Saint Petersburg, 191014
A. V. Vovk
Elizabethan Hospital
Russian Federation
Russian Federation
Andrey V. Vovk - Candidate of Medical Sciences, Deputy Chief Physician for Medical Affairs, Elizabethan Hospital.
Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
A. V. Osipov
Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine
Russian Federation
Russian Federation
Aleksey V. Osipov - Candidate of Medical Sciences, Senior Researcher, Department of Emergency Surgery, I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine.
Budapestskaya Str. 3, lit. A, Saint Petersburg, 192242
V. I. Serdyuk
Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine
Russian Federation
Russian Federation
Valentin I. Serdyuk - Deputy Chief Physician for Surgery, I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine.
Budapestskaya Str. 3, lit. A, Saint Petersburg, 192242
D. A. Chernyshev
Elizabethan Hospital
Russian Federation
Russian Federation
Denis A. Chernyshev - Candidate of Medical Sciences, Deputy Chief Physician for Surgery, Elizabethan Hospital.
avilovykh Str. 14, lit. A, Saint Petersburg, 195257
M. A. Protchenkov
City Hospital No. 26
Russian Federation
Russian Federation
Mikhail A. Protchenkov - Doctor of Medical Sciences, Deputy Chief Physician for Surgery, City Hospital No. 26.
Kostyushko Str. 2, Saint Petersburg, 196247
I. I. Gubkov
Elizabethan Hospital
Russian Federation
Russian Federation
Ilya I. Gubkov - Candidate of Medical Sciences, Head of Surgical Department No. 1, Elizabethan Hospital.
Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
M. G. Zaitsev
Elizabethan Hospital
Russian Federation
Russian Federation
Maksim G. Zaitsev - Candidate of Medical Sciences, Head of Surgical Department No. 2, Elizabethan Hospital Elizabethan Hospital.
Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
S. Yu. Puzanov
Elizabethan Hospital
Russian Federation
Russian Federation
Sergey Yu. Puzanov - Candidate of Medical Sciences, Head of Surgical Department No. 3, Elizabethan Hospital.
Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
A. A. Kozobin
Elizabethan Hospital
Russian Federation
Russian Federation
Aleksandr A. Kozobin - Candidate of Medical Sciences, Surgeon, Surgical Department No. 3, Elizabethan Hospital.
Vavilovykh Str. 14, lit. A, Saint Petersburg, 195257
O. V. Babkov
Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine
Russian Federation
Russian Federation
Oleg V. Babkov - Candidate of Medical Sciences, Head of the 3rd Surgical Department, I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine.
Budapestskaya Str. 3, lit. A, Saint Petersburg, 192242
A. V. Glebova
City Mariinsky Hospital
Russian Federation
Russian Federation
Anna V. Glebova - Candidate of Medical Sciences, Associate Professor, Surgeon, Mariinsky City Hospital.
Liteiny Ave. 56, Saint Petersburg, 191014
D. S. Sakhno
Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine
Russian Federation
Russian Federation
Denis S. Sakhno - Surgeon, Surgical Department No. 1, I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine.
Budapestskaya Str. 3, lit. A, Saint Petersburg, 192242
D. V. Gurzhiy
I.I. Mechnikov North-West State Medical University
Russian Federation
Russian Federation
Dmitry V. Gurzhiy - Candidate of Medical Sciences, Associate Professor, I.I. Grekov Department of Faculty Surgery with the Course of Endoscopy, I.I. Mechnikov North-Western State Medical University.
Kirochnaya Str., 41, Saint Petersburg, 191015
V. P. Zemlyanoy
I.I. Mechnikov North-West State Medical University
Russian Federation
Russian Federation
Vyacheslav P. Zemlyanoy - Doctor of Medical Sciences, Professor, Head of the I.I. Grekov Department of Faculty Surgery with the Course of Endoscopy, I.I. Mechnikov North-Western State Medical University.
Kirochnaya Str., 41, Saint Petersburg, 191015
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For citations:
Sigua B.V., Demko A.E., Petrov S.V., Kotkov P.A., Soloviev I.A., Vovk A.V., Osipov A.V., Serdyuk V.I., Chernyshev D.A., Protchenkov M.A., Gubkov I.I., Zaitsev M.G., Puzanov S.Yu., Kozobin A.A., Babkov O.V., Glebova A.V., Sakhno D.S., Gurzhiy D.V., Zemlyanoy V.P. Comparative Effectiveness of Early and Delayed Surgical Interventions in Patients with Acute Adhesive Intestinal Obstruction: A Multicenter Controlled Randomized Trial Prospective Study. Russian Sklifosovsky Journal "Emergency Medical Care". 2025;14(1):69-80. (In Russ.) https://doi.org/10.23934/2223-9022-2025-14-1-69-80
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