INTESTINAL-OBSTRUCTION DUE TO POSTOPERATIVE ADHESIONS IN PEDIATRIC-PATIENTS

Between 1972 and 1990, 104 pediatric patients with intestinal obstruct ion due to postoperative adhesions were treated either nonsurgically ( n = 26) or by laparotomy (n = 78) with (n = 28) or without intestinal resection. The mortality rate was 6.7 %. The distribution of initial s urgical procedures was as follows: neonatal procedure, n = 24; idiopat hic intussusception, n = 5, Nissen procedure, n = 4, posttraumatic spl enectomy, n = 3; appendectomy, n = 47, and miscellaneous procedures, n = 21. Fifty-three patients developed a septic complication after the initial procedure, and 22 had recurrent intestinal obstruction due to adhesions. The time intervals between initial surgery and obstruction are given. Critical analysis of surgical indications should allow to r educe the frequency of intestinal obstruction due to adhesions. Video- assisted surgery has proved feasible for only half the procedures know n to be commonly responsible for adhesions. Also, there is no convinci ng evidence that laparoscopic procedures do not induce adhesions. From 1991 to 1994, 11 patients (three girls and six boys; mean age, 3.9 ye ars; age range, 5-14 years) were treated for intestinal obstruction du e to postoperative adhesions, two by nonsurgical means and nine by lap aroscopic surgery. Conversion from laparoscopic to open surgery was re quired in three cases. Duration of the laparoscopic procedure ranged f rom 25 to 50 minutes (mean, 45 min). Mean time to passage of the first stool was 17 hours after laparoscopic surgery versus 72 hours after o pen surgery. These data together with the smooth postoperative course in the laparoscopically-treated patients suggest that intestinal obstr uction due to adhesions may be an excellent indication for laparoscopi c surgery.