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Subject Area

Ophthalmology

Article Type

Original Study

Abstract

Objective The objective of this study was to evaluate the efficacy and safety of fibrinolytic drugs in the prevention of adhesive intestinal obstruction in high-risk patients. Background Postoperative peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Fibrin plays an important role in postoperative adhesion formation. Resolution of the intraperitoneal fibrin deposits is essential for proper restoration of preoperative, noninflamed conditions. Patients and methods This randomized controlled trial study included 60 patients randomized into two groups (A and B). Each group included 30 patients presented with bacterial peritonitis of different causes. All patients were treated surgically. Patients in group A were managed intraoperatively by peritoneal toilet with abundant warm isotonic saline until obtaining a clear fluid after excision or repair of the cause of peritonitis with subsequent intraperitoneal instillation of one vial of streptolase (1 500 000 IU of streptokinase) diluted in 500 ml; of isotonic saline, but patients in group B were managed by good peritoneal toilet with abundant warm isotonic saline only. Patients in both groups were followed up for a period of 2 years for the incidence of postoperative adhesive intestinal obstruction and for any complication related to intraperitoneal instillation of streptokinase in group A. Results The incidence of postoperative adhesive intestinal obstruction was one patient from the 30 (3.3%) patients of group A versus six (20%) patients from the 30 patients of group B, with a statistically significant difference between both groups in the incidence of postoperative adhesive intestinal obstruction (P = 0.041) with no documented complications related to intraperitoneal instillation of streptokinase. Conclusion Local intraperitoneal instillation of streptokinase can be used safely in decreasing the incidence of adhesive intestinal obstruction in high-risk patients.

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