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RESULTS OF SURGICAL TREATMENT OF VISCEROPTOSIS USING
TRADITIONAL APPROACHES
Khusanov S.M.
Botirov A.K.
Mamajonova D.M.
Botirov J.A.
Andijan State Medical Institute, Uzbekistan
https://doi.org/10.5281/zenodo.15128584
Relevance of the Problem.
Visceroptosis (Glenard’s syndrome,
splanchnoptosis, enteroptosis)
is a condition in which the intestinal loops are
positioned below their normal anatomical location. This disorder develops due
to the prolapse of internal organs caused by weakness of the reticuloendothelial
system, rapid weight loss, and abdominal wall stretching [2].
The manifestations of chronic dysfunctions of the colon in visceroptosis
attract the attention of surgeons only at the stage of subcompensated and
decompensated colostasis. Researchers reasonably believe that prolonged
conservative treatment of visceroptosis, leading to sub- and decompensation, is
unjustified, as it often results in a high recurrence rate—ranging from 17.6% to
45.9% [1,3]. This issue is due to the inadequacy of criteria for assessing motor
dysfunction of the colon and the lack of standardized approaches for
determining indications for surgical intervention, the extent of resection, and the
methods for creating interintestinal anastomoses.
The aim of the study was to conduct a retrospective analysis of the
outcomes of surgical treatment for visceroptosis combined with chronic
colostasis using traditional approaches.
Materials and Methods.
The subject of this study comprised 132 patients
with visceroptosis combined with chronic colostasis (CC) who underwent
inpatient treatment in the coloproctology department of the Surgery and Civil
Defense Department at the Clinic of Andijan State Medical Institute.
In accordance with the study's objectives, the comparison group (2018–
2022) included 85 (64.4%) patients who underwent a retrospective analysis of
surgical treatment outcomes following traditional approaches.
To achieve the set objectives, clinical-laboratory, instrumental, and
statistical studies were conducted in accordance with the latest standard
methodologies and examination guidelines approved by the Ministry of Health
of the Republic of Uzbekistan.
Results and Discussion.
An analysis of the gender distribution of patients
with visceroptosis combined with chronic colostasis in elective surgery settings
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showed that men accounted for 16 cases (18.8%), while women constituted 69
cases (81.2%). The conducted analysis revealed that the condition is
predominantly diagnosed in females, with an average ratio of 4.3:1.
Visceroptosis combined with chronic colostasis was most frequently
diagnosed in the 45–59 age group (middle age) – 43 cases (50.6%), representing
the most economically active segment of the population, who are more
frequently exposed to external factors. In the 18–44 age group (young adults),
the condition was diagnosed in 23 cases (27.1%), primarily associated with
congenital developmental anomalies. Patients aged 60 years and older (elderly)
accounted for 19 cases (22.4%), which may indicate an excessively prolonged
course of conservative treatment.
Surgical intervention was performed in 24 patients (28.2%) with a disease
duration of 1–5 years, in 45 patients (52.9%) with a duration of 6–10 years, and
in 16 patients (18.8%) with a disease duration of more than 10 years.
It is important to note that visceroptosis was most frequently diagnosed in
patients with an asthenic div type—52 cases (61.2%), followed by a
normosthenic div type—29 cases (34.1%), and least commonly in patients
with a hypersthenic div type—only 4 cases (4.7%). The
clinical
symptom
complex of visceroptosis combined with chronic colostasis consisted of both
general and local symptoms. Constipation, as the primary manifestation of
visceroptosis, was observed in 74 patients (87.1%), while alternating
constipation and diarrhea occurred in 11 patients (12.9%). A feeling of
heaviness in the abdomen was reported in 63 patients (74.1%), intestinal
bloating in 58 patients (68.2%), and varying degrees of pain in 80 patients
(94.1%). Abdominal sagging and striae were noted in 17 patients (20.0%),
diastasis of the anterior abdominal wall muscles in 5 patients (5.9%), and
intoxication symptoms (weakness, dizziness, nervousness) in 55 patients
(64.7%).
The degree of visceroptosis compensation (constipation lasting less than 3–
4 days) was identified in 14 cases (16.5%). Subcompensation (constipation
lasting 5–10 days) was observed in 41 cases (48.2%), while decompensation
(constipation lasting more than 10 days) was recorded in 30 cases (35.3%).
Among the types of visceroptosis, the smallest group consisted of patients
with transversoptosis and deformation of the right colonic flexure, diagnosed in
14 cases (16.5%). Of these, the compensated stage was noted in 2 patients
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(2.4%), the subcompensated stage in 4 patients (4.7%), and the decompensated
stage in 2 patients (2.4%).
The largest group consisted of patients with transversoptosis and
deformation of the left colonic flexure, diagnosed in 41 cases (48.2%). Among
them, 12 patients (14.1%) had a compensated stage, 26 patients (30.6%) had a
subcompensated stage, and 17 patients (20.0%) had a decompensated stage.
Additionally, transversoptosis with deformation of both colonic flexures was
found in 30 cases (35.3%), of which 11 cases (12.9%) were subcompensated and
11 cases (12.9%) were decompensated.
Among the studied patients, the most frequently diagnosed comorbidities
were cardiovascular diseases (ischemic heart disease, hypertension, angina) in
14 cases (16.5%), hepatobiliary system disorders (type 2 diabetes mellitus,
chronic cholecystitis) in 6 cases (7.1%), chronic obstructive pulmonary diseases
(chronic bronchitis, pneumonia, bronchial asthma) in 5 cases (5.9%), and
urinary system diseases (chronic pyelonephritis, cystitis) in 7 cases (8.2%).
Patients with visceroptosis combined with chronic colostasis had a history
of various surgical interventions in 30 cases (35.3%). Notably, there was a
relatively high frequency of cesarean sections—13 cases (15.3%)—as well as
surgeries for large ventral hernias and diastasis of the anterior abdominal wall
muscles—6 cases (7.1%).
The conducted analysis suggests that multiple pregnancies (cesarean
sections) and the presence of large ventral hernias with muscle diastasis play a
certain role in the development and progression of visceroptosis. Additionally, a
history of cholecystectomy was recorded in 2 cases (2.4%), appendectomy in 5
cases (5.9%), and hysterectomy with extirpation in 4 cases (4.7%).
Out
of
the total number of patients with visceroptosis combined with chronic colostasis
(85), surgical treatment was performed in 62 cases (72.9%). Colectomy was
performed in 8 patients (9.4%), subtotal colectomy in 16 patients (12.1%),
sigmoid colon resection in 21 patients (24.7%), left-sided hemicolectomy in 12
patients (14.1%), and right-sided hemicolectomy in 5 patients (5.9%).
Conservative treatment was administered to 23 patients (27.1%), of whom 12
(14.1%) were in the compensated stage and 11 (12.9%) in the subcompensated
stage.
All postoperative complications were categorized as follows:
complications related to the formation of the intestinal anastomosis:
anastomotic leakage with peritonitis development; anastomotic leakage with the
formation of a fecal fistula; postoperative anastomosis inflammation
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complications related to the extent of colon resection: persistent
constipation; diarrhea; recurrence of visceroptosis
complications associated with the surgical wound: postoperative wound
infection; infiltration; ligature fistula
general postoperative complications unrelated to surgery, which can occur
in other procedures as well: pulmonary embolism; hypertensive crisis;
bronchopulmonary complications; other conditions
Preoperative preparation, the choice of the extent of colon resection, the
method of intestinal anastomosis formation, and postoperative management of
this patient group were carried out in accordance with established standards. In
this regard, we conducted a separate study on the results of surgical treatment
of visceroptosis combined with chronic colostasis in the comparison group and
the main group.
In the comparison group, among postoperative complications related to the
formation of the intestinal anastomosis, anastomotic leakage with the
development of generalized peritonitis was observed in 2 patients (3.2%). Due
to late diagnosis and, consequently, delayed reintervention, one case (1.6%)
resulted in a fatal outcome. Anastomotic leakage with localized process
restriction and the formation of a fecal fistula was noted in 1 patient (1.6%),
requiring a planned repeat surgical intervention for fistula elimination.
Postoperative anastomosis inflammation was recorded in 2 patients (3.2%),
necessitating prolonged specialized conservative treatment. Overall,
complications characteristic of intestinal surgeries were observed in 5 patients
(8.1%) in the comparison group, with one fatal outcome (1.6%). A retrospective
analysis established that these complications were due to certain shortcomings
in preoperative preparation, as well as adherence to several traditional
approaches in the formation of intestinal anastomosis and postoperative
management of patients in the comparison group.Among the postoperative
complications related to the extent of colon resection, persistent constipation
was observed in 5 patients (8.1%), indicating an insufficient resection of the
colon. Diarrhea was noted in 4 patients (6.5%), which, on the contrary,
suggested an excessive resection of the colon. Recurrence of visceroptosis was
observed in 3 patients, indicating inadequate fixation of the ligamentous
apparatus and an insufficient volume of colon resection. The analysis
established that when determining the extent of colon resection and its fixation,
there was a pressing need to refine the indications for selecting the surgical
intervention volume and ensuring its proper fixation.
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Among postoperative complications, surgical wound suppuration was
recorded in 3 patients (4.8%), wound infiltration in 3 patients (4.8%), and
ligature fistula in 1 patient (1.6%). As a result of the analysis, we concluded that
the systematic and targeted use of antibiotics, meticulous hemostasis along the
surgical wound, and the use of modern suture materials are of critical
importance.
In the comparison group, among general postoperative complications,
pulmonary embolism was observed in 1 patient (1.6%), indicating an
insufficient scope of preventive measures, which must be conducted under the
control of the coagulation and anticoagulation system. Hypertensive crisis was
recorded in 1 patient (1.6%), suggesting inadequate antihypertensive therapy in
a patient with hypertension. Bronchopulmonary complications were noted in 4
patients (6.4%), indicating insufficient prevention and appropriate therapy,
although 2 of them underwent surgery during the winter period and were
chronic smokers.
Conclusion.
Thus, in the comparison group, it was established that the
causes of complications in the early postoperative period were certain
shortcomings in preoperative preparation, in determining the extent of colon
resection, in the method of intestinal anastomosis formation, and in
postoperative management. This highlighted the urgent need to introduce
corrections into the surgical strategy.
References:
1.
Achkasov S.I. Anomalies of the Development and Position of the Large
Intestine: Clinic, Diagnosis, Treatment. Doctor of Medical Sciences Dissertation
Abstract. Moscow, 2003. 31 p.
2.
Visceroptosis – Causes, Symptoms, Diagnosis, and Treatment.
https://www.krasotaimedicina.ru/diseases/zabolevanija_gastroenterologia/vis
ceroptosis, 2024.
3.
Dzhavadov E.A. Surgical Treatment of Chronic Colostasis. Surgery. Journal
Named After N.I. Pirogov. 2009, No. 12, pp. 60–62.
