Тew sights on the assessment of adhesive disease severity

Abstract

The paper describes a new classification of the adhesive process in the abdominal cavity, depending on the severity of the adhesive process and the possibility of influencing them surgically. According to this classification, 5 degrees are distinguished. At grade 1, single viscero-visceral or viscero-parietal planar adhesions were detected, easily dissected in a blunt way. At grade 2 - viscero-visceral and viscero-parietal adhesions, the dissection of which must be performed in an acute way, while the integrity of the intestinal walls is maintained. At grade 3, there were viscero-parietal adhesions, the dissection of which requires excision of the walls of the abdominal wall in order to preserve the integrity of the intestinal walls, or viscero-visceral adhesions, the dissection of which contributes to single areas of deserosis of the intestinal walls. At grade 4, there were viscero-visceral or viscero-parietal adhesions with intimate adhesions between intestinal loops; attempts to dissect them in an acute way lead to severe violations of the integrity of the intestinal walls. At grade 5, detected an adhesive conglomerate of the abdominal cavity, while the isolation of intestinal loops is not possible. The results of treatment of 148 patients were analyzed. The frequency of postoperative complications was 20.3%, and the mortality rate was 6.1%. The analysis performed showed the dependence of the frequency of postoperative complications and mortality on the severity of the adhesive process.