Postoperative Intestinal Obstruction after Laparoscopic Versus Open Surgery in the Pediatric Population: A 15-year Review

Abstract Abdominal exploration (ARE) is an important complication of abdominal surgery and has an effect on morbidity and mortality. ARE refers to exploration performed within 60 days following initial surgery. The purpose of this study is to know the grounds for performing re-exploration and its effects on the outcome. Methods This retrospective study was carried out in the pediatric surgery unit of Khyber teaching hospital from May 2017 to May 2019. All patients under the age of 16 years who underwent abdominal re-exploration within 60 days of the initial procedure were included in the study. Results A total of 55 re-exploration were done in the study duration of 2 years. The mean age of patients was 41 months (range of 0.06 to 168 months) male patients were 64%. On initial presentation, 56% of cases were emergency cases and 44% were elective. Common indications for re-exploration were, intestinal obstruction 29.1%, peritonitis 16.4%, complications of stoma 16.4%, burst abdomen 10.9%. The mean interval from initial surgery was 12.5±13.7 days. Common operative findings of re-exploration were inter-loop adhesions, anastomotic disruption, burst abdomen, anastomotic leak, intra-abdominal collection, gangrenous stoma, and para-stomal herniation. ARE resulted in 14.5% mortality. Conclusion Abdominal re-exploration is mainly indicated for intestinal obstruction and peritonitis. Inter loop adhesions and anastomotic leak are common surgical findings during re-exploration. The mortality rate is high in patients re-explored for peritonitis, fecal fistula, abdominal collection, and wound dehiscence.

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Multivariate machine learning models for prediction of postoperative intestinal obstruction in patients underwent laparoscopic colorectal surgery: A retrospective observational study

10.21203/rs.2.18587/v1 ◽

2019 ◽

Author(s):

Xueyan Li ◽

Genshan Ma ◽

Xiaobo Qian ◽

Yamou Wu ◽

Xiaochen Huang ◽

...

Keyword(s):

Machine Learning ◽

Colorectal Surgery ◽

Intestinal Obstruction ◽

Laparoscopic Colorectal Surgery ◽

Training Group ◽

Machine Learning Algorithms ◽

Gradient Boosting ◽

Duration Of Surgery ◽

Postoperative Intestinal Obstruction ◽

Testing Group

Abstract Background Machine learning may predict postoperative intestinal obstruction (POI) in patients underwent laparoscopic colorectal surgery for malignant lesions.Methods We used five machine learning algorithms (Logistic regression, Decision Tree, Forest, Gradient Boosting and gbm), analyzed by 28 explanatory variables, to predict POI. The total samples were randomly divided into training and testing groups, with a ratio of 8:2. The model was evaluated by the area operation characteristic curve (AUC), F1-Measure, accuracy, recall, and MSE under the receiver.Results A total of 637 patients were enrolled in this study, 122 (19.15%) of them had POI. Gradient Boosting and gbm had the most accurate in training group and testing group respectively.The f1_score of Gradient Boosting was the highest in the training group (f1_score =0.710526), and the f1_score of gbm was the highest in the testing group (f1_score =0.500000). In addition, the results of the importance matrix of Gbdt algorithm model showed that the important variables that account for the weight of intestinal obstruction after the first five operations are time to pass flatus or passage of stool, cumulative dose of rescue opioids used in postoperative days 3 (POD 3), duration of surgery, height and weight.Conclusions Machine learning algorithms may predict the occurrence of POI in patients underwent laparoscopic colorectal surgery for malignant lesions, especially Gradient Boosting and GBM algorithms. Moreover, time to pass flatus or passage of stool, cumulative dose of rescue opioids used during POD 3, duration of surgery, height and weight play an important role in the development of POI.

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Early Postoperative Intestinal Obstruction Following Surgery for Colorectal Cancer.

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.54.323 ◽

2001 ◽

Vol 54 (5) ◽

pp. 323-327 ◽

Cited By ~ 1

Author(s):

Y. Nakajima ◽

K. Takahashi ◽

M. Yasuno ◽

T. Mori

Keyword(s):

Colorectal Cancer ◽

Intestinal Obstruction ◽

Postoperative Intestinal Obstruction

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Patterns and Surgical Outcome of Pediatric Intestinal Obstruction in Pakistan

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2021.11.1.39-44 ◽

2021 ◽

Vol 11 (1) ◽

pp. 39-44

Author(s):

Ali Raza Chaudhry ◽

Muhammad Umar Nisar ◽

Anwar Khan ◽

Nadeem Akhtar ◽

Samer Sikander ◽

...

Keyword(s):

Intestinal Obstruction ◽

Surgical Outcome ◽

Pediatric Population ◽

Geographical Area ◽

Hypertrophic Pyloric Stenosis ◽

Hirschsprung Disease ◽

Sampling Technique ◽

Mesenteric Cyst ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Rectal Atresia

Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan

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