Terapi Operatif Vs Non-Operatif untuk Adhesive Small Bowel Obstruction

Oleh :

dr. Harris Bartimeus, Sp.B

Terapi untuk obstruksi usus halus adhesif atau adhesive small bowel obstruction (ASBO) dapat dilakukan secara non-operatif maupun operatif. Terapi non-operatif merupakan terapi lini pertama untuk sebagian besar pasien ASBO. Terapi non-operatif pada ASBO harus disertai dengan kesiapan untuk konversi ke terapi operatif apabila dalam perjalanan penyakitnya terjadi perburukan klinis.[1,2]

Sekitar 75% dari kasus obstruksi usus halus disebabkan karena ASBO. ASBO sendiri biasanya berkaitan dengan riwayat operasi abdomen sebelumnya. Patogenesis terjadinya ASBO banyak dikaitkan dengan adanya ketidakseimbangan antara pembentukan fibrin dan fibrinolisis dalam proses penyembuhan luka operasi abdomen.[2,3]

Fibrin akan berubah menjadi adhesi yang permanen dan menyebabkan ASBO. Faktor risiko terjadinya ASBO adalah riwayat operasi abdomen berulang, terutama bila lokasi operasinya di pelvis dan rektum.[2,3]

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. ten Broek RP, Krielen P, et al. 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. 2018Jun19;13(1). https://doi.org/10.1186/s13017-018-0185-2
2. Tong JW, Lingam P, Shelat VG. Adhesive small bowel obstruction – an update. Acute Medicine & Surgery. 2020Sep18;7(1). doi: 10.1002/ams2.587
3. 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):159–69. https://doi.org/10.1177/1457496920982
4. Behman R, Nathens AB, et al. Association of surgical intervention for adhesive small-bowel obstruction with the risk of recurrence. JAMA Surgery. 2019Jan30;154(5):413–20. https://doi.org/10.1001/jamasurg.2018.5248.
5. Ooi A, Cama JK, et al. Non-operative management of adhesive intestinal obstruction in children over a 12 year period at Waikato Hospital. Pacific Health Dialog. 2021Jun22;21(7):433–9. DOI: 10.26635/phd.2021.106
6. Kanase VV, Gutam A, et al. Management of Adhesive Small Bowel Obstruction Using Gastrografin . European Journal of Molecular & Clinical Medicine . 2020;7(1):4162–7.
7. Zhou C, Udwadia FR, et al. Using Gastrografin to manage adhesive small bowel obstruction: A nonrandomized controlled study with historical controls. BC Medical Journal. 2021;63(6):247–51.
8. Jung K-S, Choi KJ, et al. Feasibility of the gastrografin challenge for adhesive small bowel obstruction. Journal of Acute Care Surgery. 2021Jul7;11(2):58–63. https://doi.org/10.17479/jacs.2021.11.2.58
9. Bauer J, Keeley B, et al. Adhesive small bowel obstruction: Early operative versus observational management. The American Surgeon. 2015;81(6):614–20.
10. Tabchouri N, Dussart D, et al. Only surgical treatment to be considered for adhesive small bowel obstruction: A new paradigm. Gastroenterology Research and Practice. 2018:1–6. https://doi.org/10.1155/2018/9628490
11. Behman R, Karanicolas PJ, et al. Hospital-level variation in the management and outcomes of patients with adhesive small bowel obstruction. Annals of Surgery. 2019Dec10;274(6):1063–70. doi: 10.1097/SLA.0000000000003739
12. Behman R, Nathens AB, et al. Early operative management in patients with adhesive small bowel obstruction: Population-based cost analysis. BJS Open. 2020Jun30;4(5):914–23. DOI: 10.1002/bjs5.50311