Comparative Effectiveness of Early and Delayed Surgical Interventions in Patients with Acute Adhesive Intestinal Obstruction: A Multicenter Controlled Randomized Trial Prospective Study

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.