Comparative effectiveness of small bowel decompression methods in patients with benign small bowel obstruction: results of a multicenter non-randomized controlled retrospective study

Introduction . The success of treatment of patients with acute intestinal obstruction is determined by many factors, including the correction of intra-abdominal hypertension and endotoxicosis through intraoperative decompression of the small intestine. The absence of a convincing evidence base in domestic practice in favor of choosing a specific method of probe decompression of the intestine in patients with acute intestinal obstruction served as the basis for this comparative study. The objective was to evaluate the effectiveness and safety of small intestinal decompression methods in patients with benign forms of intestinal obstruction. Methods and materials . This work was carried out in the format of a multicenter cohort retrospective study, which included an analysis of the treatment results in 315 patients operated with benign forms of intestinal obstruction, who underwent one of 3 intestinal decompression methods. Comparison groups were formed using an optimal matching procedure to avoid the influence of selected confounders on the outcome. The immediate results of treatment were assessed. Results . The choice between simple nasogastric drainage and insertion of a tube through the ligament of Treitz does not affect rather the rate of adequate peristalsis restoration in the postoperative period, nor the frequency and structure of postoperative complications and deaths. On the contrary, the installation of a long intestinal tube does not accelerate the recovery of peristalsis, since in patients with a nasogastric tube, adequate intestinal activity was recorded on average a day earlier. No effect of nasointestinal intubation on the frequency and structure of non-lethal complications was found, which couldn’t be said about postoperative mortality, which was the highest in the group of patients with long intestinal tubes. At the same time, the most common cause of death was associated with the development of an intra-abdominal complication, while such a trend was not observed among patients with short tubes. Conclusion . The installation of long intestinal tubes for intestinal decompression in patients with acute intestinal obstruction was associated with the highest mortality due to an increase in the number of intra-abdominal complications. It is impossible to make a clear choice between drainage of the initial parts of the small intestine or isolated installation of a tube in the stomach based on the data obtained.