Bowel Obstruction Following Appendectomy

Leung, Terry; Dixon, Elijah; Gill, Manpreet; Mador, Brett; Moulton, Kyle M.; Kaplan, Gilaad G.; MacLean, Anthony R.

doi:10.1097/sla.0b013e3181ad64a7

Cited by 93 publications

(51 citation statements)

References 11 publications

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“…Some asymmetry, however, is due to high incidences derived from high quality studies designed to assess incidences of small bowel obstruction or enterotomy. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] That is, some smaller low quality studies reporting lower incidences were possibly not identified. Our sensitivity analyses, however, showed that our results were quite robust, so we do not expect that these smaller low quality studies would change our results.…”

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

“…Adhesions may cause acute abdomen by bowel obstruction and female infertility, and patients may require reoperation. [5][6][7][8][9][10][11][12][13][14] Lysis of adhesions is associated with a prolonged operative time and an increased risk of intraoperative and postoperative complications. 5 14 Most of the epidemiological knowledge of adhesions has been derived from the extensive work of the Surgical and Clinical Adhesions Research (SCAR) Group.…”

Section: Introductionmentioning

confidence: 99%

“…5 14 Most of the epidemiological knowledge of adhesions has been derived from the extensive work of the Surgical and Clinical Adhesions Research (SCAR) Group. [4][5][6][7][8][9][10][11][12][13][14][15][16] They, however, defined readmissions as a proxy for the effect of adhesions, which lacks detailed information on the effect of different adhesive complications. Data on adhesion related complications are reported incidentally, and different outcome measures have been used.…”

Section: Introductionmentioning

confidence: 99%

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Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Broek

Issa

Santbrink

et al. 2013

BMJ

468

291

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Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain.Design Systematic review and meta-analyses.Data sources Searches of PubMed, Embase, and Central, from January 1990 to December 2012, without restrictions to publication status or language.Study selection All types of studies reporting on the incidence of adhesion related complications were considered.Data extraction and analysis The primary outcome was the incidence of adhesive small bowel obstruction in patients with a history of abdominal surgery. Secondary outcomes were the incidence of small bowel obstruction by any cause, difference in operative time, enterotomy during adhesiolysis, and pregnancy rate after abdominal surgery. Subgroup and sensitivity analyses were done to study the robustness of the results. A random effects model was used to account for heterogeneity between studies.Results We identified 196 eligible papers. Heterogeneity was considerable for almost all meta-analyses. The origin of heterogeneity could not be explained by study design, study quality, publication date, anatomical site of operation, or operative technique. The incidence of small bowel obstruction by any cause after abdominal surgery was 9% (95% confidence interval 7% to 10%; I 2 =99%). the incidence of adhesive small bowel obstruction was 2% (2% to 3%; I 2 =93%); presence of adhesions was generally confirmed by emergent reoperation. In patients with a known cause of small bowel obstruction, adhesions were the single most common cause (56%, 49% to 64%; I 2 =96%). Operative time was prolonged by 15 minutes (95% confidence interval 9.3 to 21.1 minutes; I 2 =85%) in patients with previous surgery. Use of adhesiolysis resulted in a 6% (4% to 8%; I 2 =89%) incidence of iatrogenic bowel injury. The pregnancy rate after colorectal surgery in patients with inflammatory bowel disease was 50% (37% to 63%; I 2 =94%), which was significantly lower than the pregnancy rate in medically treated patients (82%, 70% to 94%; I 2 =97%).Conclusions This review provides detailed and systematically analysed knowledge of the disease burden of adhesions. Complications of postoperative adhesion formation are frequent, have a large negative effect on patients' health, and increase workload in clinical practice. The quantitative effects should be interpreted with caution owing to large heterogeneity.

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Section: Strengths and Limitations Of Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Broek

Issa

Santbrink

et al. 2013

BMJ

468

291

View full text Add to dashboard Cite

show abstract

“…A study by Anderson reviewing small bowel obstruction after appendicectomy, (13) reported a cumulative risk of surgically treated small bowel obstruction after appendicectomy of 0.41% after 4 weeks, 0.63% after 1 year and 1.30% after 30 years of follow-up, compared with 0.003% at 1 year and 0.21% after 30 years of follow-up among a conservatively managed group. In another review of 1,777 patients who had an appendicectomy for acute appendicitis, the overall small bowel obstruction rate was 2.8% over an average 4.1-year follow-up (26). Laparoscopic appendicectomy is associated with less postoperative pain and a reduced hospital stay, but it also carries risks as follows: intra-operative complications (0.7% to 3.1%), postoperative complications (1.9% to 6.1%) and re-operation rates ranging from 0.7 % to 3.4% (27).…”

Section: Efficacymentioning

confidence: 99%

What Is the Role of Conservative Antibiotic Treatment in Early Appendicitis?

Chamisa¹

2012

Appendicitis - A Collection of Essays From Around the World

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“…Although it is well tolerated by most patients, it can be associated with postoperative complications in a significant number of individuals: small bowel obstruction requiring surgical intervention occurs in 3% of patients undergoing appendectomy over 10 years [1]. Furthermore, more than 15% of individuals with suspected acute appendicitis have a normal appendix at laparotomy, with a higher percentage in infants, young women and elderly patients [2].…”

Section: Introductionmentioning

confidence: 99%