Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery

Park

et al. 2018

J Minim Invasive Surg

Purpose: Laparoscopic adhesiolysis is increasingly used to treat patients with small bowel obstruction (SBO), however, its safety of laparoscopic surgery(LS) with bowel resection in SBO is unclear. The purpose of the present study was to compare the perioperative outcomes of LS with those of open surgery (OS) for SBO and to evaluate the risk factors of 30-day postoperative morbidity and recurrence. Methods:We retrospectively reviewed medical records of patients who had been diagnosed with SBO and underwent surgery at four Hallym-University-affiliated hospitals between January 2013 and December 2016. The rates of 30-day postoperative complications and recurrence were compared between groups using univariate and multivariate analysis. Propensity score matching was performed to compare the outcome.Results: A total of 117 patients with SBO were included in the present study, of which 86 underwent OS and 31 underwent LS. Time to water intake, time to soft diet, and postoperative hospital stay were significantly shorter in the LS group (p=0.002, 0.003, and 0.027, respectively). The complication (p=0.249) and recurrence rate (p=0.679) were similar between the two group. Propensity score matching analysis demonstrated that laparoscopic surgery showed quicker recovery and similar complication and recurrence rate. In multivariate analysis, LS was not associated with either complications (p=0.806) or recurrence (p=0.956). Conclusion:LS is associated with several perioperative advantages for the treatment of SBO without affecting the risk of 30-day postoperative complications or recurrence. Therefore LS can be a safe and feasible option for treating SBO.

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Laparoscopic Surgery for Small Bowel Obstruction

Park

et al. 2018

J Minim Invasive Surg

“…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%

“…Evidence shows that adhesion barriers effectively reduce adhesion formation in high risk surgery. [13][14][15][16][17][18][19][20][21][22][23][24] The detailed knowledge of the disease burden of adhesions now available may be used to power future trials of anti-adhesive barriers preventing clinically relevant outcomes of adhesions.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

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

Broek

Issa

Santbrink

et al. 2013

BMJ

466

291

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.

“…Adhesive SBO is a hazard especially of colon resection, affecting 15% within 2 years following surgery [3]. On the other hand, colon resection is a dominant precursor of early [4, 5]and late postoperative adhesive SBO [6, 7]in a population undergoing various abdominal procedures.…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction following Extended Right Hemicolectomy and Subtotal Colectomy: Assessing the Benefit of Prophylactic Tube Splinting / with Invited Commentary

Meissner

2001

Dig Surg

Background/Aims: Small bowel obstruction (SBO) is a frequent complication of extended right hemicolectomy and subtotal colectomy. This study was conducted to assess the prophylactic effectiveness of intestinal tube splinting. Methods: Sixteen patients (study group) undergoing extended right hemicolectomy or subtotal colectomy were treated with and 18 patients (controls) without splinting. Clinical, operative and outcome data were entered into a maintained database. The main endpoint was subsequent SBO. Results: After a follow-up of 2–13 (median 6.5) years, the study group remained free from SBO. After 1–16 years (median 2), four complete and one partial early and one complete and one complete recurrent late SBO occurred in controls. Conclusion: Intestinal tube splinting was comparatively easy and expeditious from a technical point of view after extended hemicolectomy and subtotal colectomy. The procedure eliminated early and up to date also late postoperative SBO in this study and can be considered as a prophylaxis against SBO in this subset of patients.