GENETIC DETERMINATION OF POSTOPERATIVE INTESTINAL PARESIS IN THE BACKGROUND OF PERITONITIS

Postoperative intestinal paresis remains an urgent problem of abdominal surgery, since it is one of the most common postoperative complications in terms of frequency. In most studies, the violation of the motor function of the intestine after surgery on the hollow organs of the digestive system is considered as a pathological process, is a consequence of postoperative peritonitis. The paper presents data on the relationship between the variants of the SERT gene, which regulates the reuptake of serotonin, with the concentration in the blood plasma and the likelihood of postoperative intestinal paresis and peritonitis. This made it possible not only to predict the occurrence of postoperative disorders of the motor-evacuation function of the intestine, but also to improve the algorithms for their prevention and pathogenetically justified treatment. It has been established that it is with the SS-genotype that postoperative disorders of the motor-evacuation function of the intestine occur more often, which lead to peritonitis. This leads to a change in treatment tactics in such patients. If these unfavorable genotype variants are found for surgery in such patients, we consider it expedient to expand the indications for intestinal intubation even without intraoperative manifestations of its paresis. We have proposed a technique in which nasointestinal intubation of the small intestine is first performed, which is necessary for the main stage of the operation. If it is necessary to withdraw the stoma, the indications for which in patients with unfavorable genotype variants are considered appropriate to expand, the intubation probe is cut off at the first opening, which is placed in the stomach, and the other end is withdrawn through the stoma. This greatly simplifies the technique of bowel intubation, avoids various complications associated with retrograde intubation, and, first of all, wound infection. Studies indicate a high risk of developing postoperative peritonitis in surgical patients who, after surgical interventions on the digestive organs, had pronounced disorders of the motor-evacuation function of the intestine. Improved algorithms for the treatment of such patients make it possible to significantly reduce the risk of developing postoperative intestinal paresis and peritonitis, and, if they occur, to effectively eliminate their manifestations.