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Tyagunov A.E.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Alieva Z.M.

Pirogov Russian National Research Medical University

Tyagunov A.A.

Pirogov Russian National Research Medical University

Nechai T.V.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No.1

Tsulaya A.Z.

Buyanov Moscow City Clinical Hospital

Yusufov M.P.

Buyanov Moscow City Clinical Hospital

Polushkin V.G.

LLC «Moscow Rehabilitation Center «

Sazhin A.V.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Mirzoyan A.T.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Glagolev N.S.

Pirogov Russian National Research Medical University;
BaumanMoscow City Hospital No. 29

Tavadov A.V.

Moscow Multi-Field Clinical Center «Kommunarka»

Makhuova G.B.

Pirogov Russian National Research Medical University;
Buyanov Moscow City Clinical Hospital

Sazhin I.V.

Pirogov Russian National Research Medical University;
Buyanov Moscow City Clinical Hospital

Stradymov E.A.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Kurashinova L.S.

Moscow Multi-Field Clinical Center «Kommunarka»

Lebedev I.S.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Comparison of early operative treatment and 48-hour conservative treatment in small bowel obstruction (COTACSO): intermediate results

Authors:

Tyagunov A.E., Alieva Z.M., Tyagunov A.A., Nechai T.V., Tsulaya A.Z., Yusufov M.P., Polushkin V.G., Sazhin A.V., Mirzoyan A.T., Glagolev N.S., Tavadov A.V., Makhuova G.B., Sazhin I.V., Stradymov E.A., Kurashinova L.S., Lebedev I.S.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(7): 16‑24

DOI: 10.17116/hirurgia202407116

Read: 1785 times

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Table of contents

COMPARISON OF EARLY OPERATIVE TREATMENT AND 48-HOUR CONSERVATIVE TREATMENT IN SMALL BOWEL OBSTRUCTION (COTACSO): INTERMEDIATE RESULTS
COMPARISON OF EARLY OPERATIVE TREATMENT AND 48-HOUR CONSERVATIVE TREATMENT IN SMALL BOWEL OBSTRUCTION (COTACSO): INTERMEDIATE RESULTS

To cite this article:

Tyagunov AE, Alieva ZM, Tyagunov AA, et al. . Comparison of early operative treatment and 48-hour conservative treatment in small bowel obstruction (COTACSO): intermediate results. Pirogov Russian Journal of Surgery. 2024;(7):16‑24. (In Russ.)
https://doi.org/10.17116/hirurgia202407116

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

Optimal treatment for adhesive small bowel obstruction (SBO) is not defined. Surgery is the only method of treatment for obvious strangulating SBO. Non-operative management (NOM) is widely used among patients with low risk of strangulation, i.e. no clinical, laboratory and CT signs. Randomized controlled trials (RCTs) are recommended to determine the optimal method (early intervention or NOM), but their safety is unclear due to possible delay in surgery for patients needing early intervention.

MATERIAL AND METHODS

A RCT is devoted to outcomes of early operative treatment and NOM for adhesive SBO. The estimated trial capacity is 200 patients. Thirty-two patients were included in interim analysis. In 12 hours after admission, patients without apparent signs of strangulation were randomized into two clinical groups after conservative treatment. Group I included 12 patients who underwent immediate surgery, group II — 20 patients after 48-hour NOM. The primary endpoint was success of non-surgical regression of SBO and reduction in mortality. To evaluate patient safety, we analyzed mortality, complication rates and bowel resection in this RCT with previously published studies.

RESULTS

In group I, all 12 (100%) patients underwent surgery. Only 4 (20%) patients required surgery in group II. Mortality, complication rates and bowel resection rates were similar in both groups. Strangulating SBO was found in 8 (25%) patients. Overall mortality was 6.3%, bowel resection rate — 6.3%, iatrogenic perforation occurred in 3 (18.8%) patients. These values did not exceed previous findings.

CONCLUSION

Non-operative management within 48 hours prevented surgery in 80% of patients with SBO. Interim analysis found no significant between-group differences in mortality, complication rates and bowel resection rate. Patients had not been exposed to greater danger than other patients with adhesive SBO. The study is ongoing.

Keywords:

SBO
adhesive small bowel obstruction
non-operative management
RCT

Authors:

Tyagunov A.E.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Alieva Z.M.

Pirogov Russian National Research Medical University

Tyagunov A.A.

Pirogov Russian National Research Medical University

Nechai T.V.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No.1

Tsulaya A.Z.

Buyanov Moscow City Clinical Hospital

Yusufov M.P.

Buyanov Moscow City Clinical Hospital

Polushkin V.G.

LLC «Moscow Rehabilitation Center «

Sazhin A.V.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Mirzoyan A.T.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Glagolev N.S.

Pirogov Russian National Research Medical University;
BaumanMoscow City Hospital No. 29

Tavadov A.V.

Moscow Multi-Field Clinical Center «Kommunarka»

Makhuova G.B.

Pirogov Russian National Research Medical University;
Buyanov Moscow City Clinical Hospital

Sazhin I.V.

Pirogov Russian National Research Medical University;
Buyanov Moscow City Clinical Hospital

Stradymov E.A.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Kurashinova L.S.

Moscow Multi-Field Clinical Center «Kommunarka»

Lebedev I.S.

Pirogov Russian National Research Medical University;
Moscow Multi-Field Clinical Center «Kommunarka»

Received:

21.11.2023

Accepted:

19.01.2024

Close metadata

References:

  1. Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal Adhesiolysis: Inpatient Care and Expenditures in the United States in 1994. Journal of the American College of Surgeons. 1998;186(1):1-9.  https://doi.org/10.1016/S1072-7515(97)00127-0
  2. Revishvili ASh, Sazhin VP, Olovyanniy VE, Zakharova MA. Current trends in emergency abdominal surgery in the Russian Federation. Pirogov Russian Journal of Surgery. 2020;7:6-11. (In Russ.). https://doi.org/10.17116/hirurgia20200716
  3. Tyagunov A, Tyagunov A, Nechay T, Vinogradov V, Kurashinova L, Sazhin A. Timing of surgery, intestinal ischemia and other real factors of mortality in acute adhesive small bowel obstruction: a multiple-center study. Pirogov Russian Journal of Surgery. 2021;2021(3):26-35. (In Russ.). https://doi.org/10.17116/hirurgia202103126
  4. Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, Velmahos GC, Sartelli M, Fraga GP, Kelly MD, Moore FA, Peitzman AB, Leppaniemi A, Moore EE, Jeekel J, Kluger Y, Sugrue M, Balogh ZJ, Bendinelli C, Civil I, Coimbra R, De Moya M, Ferrada P, Inaba K, Ivatury R, Latifi R, Kashuk JL, Kirkpatrick AW, Maier R, Rizoli S, Sakakushev B, Scalea T, Søreide K, Weber D, Wani I, Abu-Zidan FM, De’Angelis N, Piscioneri F, Galante JM, Catena F, Van Goor H. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World Journal of Emergency Surgery. 2018;13(1). https://doi.org/10.1186/s13017-018-0185-2
  5. Nacional’nye klinicheskie rekomendacii. Ostraya neopuholevaya tonkokishechnaya neprohodimost’. 2021. (In Russ.). https://cr.minzdrav.gov.ru/schema/327_2
  6. Sigua BV, Kotkov PA, Kalandarova DK, Zemlyanoy VP. Systematic Review of the Clinical Efficacy of Various Terms of Non-Surgical Treatment in Patients With Acute Adhesive Intestinal Obstruction. Russian Sklifosovsky Journal «Emergency Medical Care». 2023;12(1):99-109. (In Russ.). https://doi.org/10.23934/2223-9022-2023-12-1-99-109
  7. Bizer LS, Liebling RW, Delany HM, Gliedman ML. Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery. 1981;89(4):407-413. 
  8. Fevang BT, Jensen D, Svanes K, Viste A. Early Operation or Conservative Management of Patients with Small Bowel Obstruction? The European Journal of Surgery. 2002;168(8):475-481.  https://doi.org/10.1080/110241502321116488
  9. Joseph SP, Simonson M, Edwards C. ‘Let’s Just Wait One More Day’: Impact of Timing on Surgical Outcome in the Treatment of Adhesion-Related Small Bowel Obstruction. The American SurgeonTM. 2013;79(2):175-179.  https://doi.org/10.1177/000313481307900228
  10. Leung AM, Vu H. Factors Predicting Need for and Delay in Surgery in Small Bowel Obstruction. The American SurgeonTM. 2012;78(4):403-407.  https://doi.org/10.1177/000313481207800428
  11. Tabchouri N, Dussart D, Giger-Pabst U, Michot N, Marques F, Khalfallah M, Bucur P, Barbier L, Kraemer-Bucur A, Nayeri M, Thiery J, Bourbao-Tournois C, Bourlier P, Salamé E, Ouaïssi M. Only Surgical Treatment to Be Considered for Adhesive Small Bowel Obstruction: A New Paradigm. Gastroenterology Research and Practice. 2018;2018:1-6.  https://doi.org/10.1155/2018/9628490
  12. Bauer J, Keeley B, Krieger B, Deliz J, Wallace K, Kruse D, Dallas K, Bornstein J, Chessin D, Gorfine S. Adhesive Small Bowel Obstruction: Early Operative versus Observational Management. The American Surgeon. 2015;81(6):614-620. 
  13. Thornblade LW, Verdial FC, Bartek MA, Flum DR, Davidson GH. The Safety of Expectant Management for Adhesive Small Bowel Obstruction: A Systematic Review. Journal of Gastrointestinal Surgery. 2019;23(4):846-859.  https://doi.org/10.1007/s11605-018-4017-1
  14. Hajibandeh S, Hajibandeh S, Panda N, Khan RMA, Bandyopadhyay SK, Dalmia S, Malik S, Huq Z, Mansour M. Operative versus non-operative management of adhesive small bowel obstruction: A systematic review and meta-analysis. International Journal of Surgery. 2017;45:58-66.  https://doi.org/10.1016/j.ijsu.2017.07.073
  15. Khalil OH, Abdalla W, Allam Z. Early laparoscopic adhesiolysis versus conservative treatment of recurrent adhesive small intestinal obstruction: a prospective randomized controlled trial. The Egyptian Journal of Surgery. 2016;35(2):96-101.  https://doi.org/10.4103/1110-1121.182782
  16. Sallinen V, Di Saverio S, Haukijärvi E, Juusela R, Wikström H, Koivukangas V, Catena F, Enholm B, Birindelli A, Leppäniemi A, Mentula P. Laparoscopic versus open adhesiolysis for adhesive small bowel obstruction (LASSO): an international, multicentre, randomised, open-label trial. The Lancet Gastroenterology & Hepatology. 2019;4(4):278-286.  https://doi.org/10.1016/S2468-1253(19)30016-0
  17. Sazhin AV, Tyagunov AE, Larichev SE, Lebedev IS, Makhuova GB, Marchenko IP, Polushkin VG, Tyagunov AA, Sazhin IV, Nechay TV, Ivakhov GB, Titkova SM, Anurov MV, Gasanov MM, Kolygin AV, Mirzoyan AT, Glagolev NS, Kurashinova LS. Optimal time of surgery for acute adhesive small bowel obstruction. Pirogov Russian Journal of Surgery. 2018;2018(3):24-30. (In Russ.). https://doi.org/10.17116/hirurgia2018324-30
  18. Ayushinova NI, Shurygina IA, Shurygin MG, Grigor’ev EG. Hospital epidemiology of abdominal adhesions. Bulletin ESSC SB RAMS. 2016;1(4):115-118. (In Russ.). https://doi.org/10.12737/22982
  19. Schepin VO, Mirgorodskaya OV. The emergency surgical care in the russian federation. Problems of social hygiene, public health and history of medicine. 2013;1:29-33. (In Russ.).
  20. Podda M, Khan M, Di Saverio S. Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate? Scandinavian Journal of Surgery. 2021;110(2):159-169.  https://doi.org/10.1177/1457496920982763
  21. Tyagunov AE, Fedorov AV, Nechay TV, Tyagunov AA, Sazhin AV. Surgical approach for small bowel obstruction in the Russian Federation. National survey of surgeons. Pirogov Russian Journal of Surgery. 2022;5:5-17. (In Russ.). https://doi.org/10.17116/hirurgia20220515
  22. Lee MJ, Sayers AE, Wilson TR, Acheson AG, Anderson ID, Fearnhead NS. Current management of small bowel obstruction in the UK: results from the National Audit of Small Bowel Obstruction clinical practice survey. Colorectal Disease. 2018;20(7):623-630.  https://doi.org/10.1111/codi.14016
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