Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

Andersen, Peter Henrik; Jensen, Kristian K.; Erichsen, Rune; Frøslev, Trine; Krarup, Peter‐Martin; Madsen, M. R.; Laurberg, Søren; Iversen, Lene Hjerrild

doi:10.1002/bjs5.5

Cited by 16 publications

(24 citation statements)

References 29 publications

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“…The risk of surgery for SBO has been studied extensively. One study based on data from a Danish registry found this risk to be 4.5% [16], which is the same as that in the present study. Another study found the risk to be between 19 and 66% [17].…”

Section: Discussionsupporting

confidence: 89%

Risk factors for small bowel obstruction after open rectal cancer resection

et al. 2021

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Background Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery. Methods A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed. Results In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129–7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO. Conclusions One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.

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Section: Discussionsupporting

confidence: 89%

Risk factors for small bowel obstruction after open rectal cancer resection

et al. 2021

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“…Although discussion regarding the true readmission rate is ongoing. A population based study, published after the conduction of the survey, showed a slightly lower readmission rate after 5 years (4.5%)[ 13 ] after open surgery. Others report a readmission rate of 6% within 4 years.…”

Section: Discussionmentioning

confidence: 99%

“…Others report a readmission rate of 6% within 4 years. But more interestingly is the readmission rate after laparoscopic surgery, which is higher than expected (3.0%)[ 13 ]. So, the positive effect of laparoscopic surgery in comparison to open surgery on adhesion formation seems to be overestimated.…”

Section: Discussionmentioning

confidence: 99%

Adhesion awareness in 2016: An update of the national survey of surgeons

et al. 2018

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Background and aimsAdhesions, that form in 60–80% of all abdominal operations, can cause complications such as chronic abdominal pain, small-bowel obstruction, female infertility, and the need for adhesiolysis in future surgeries. Our 2010 Adhesion Awareness survey demonstrated that despite the huge clinical impact of adhesions; adhesion-related complications were seldom mentioned in the informed consent. Six years later, a follow-up survey was conducted to assess the progress on awareness on adhesion-related complications in the Netherlands.Material and methodsThe 2010 Adhesion Awareness survey was repeated after a literature update. The knowledge regarding adhesions; the use of anti-adhesive agents and involvement in the informed consent process were assessed. Surgeons and surgical trainees were contacted by e-mail. The data was analysed using a Chi-square or Mann-Whitney U test and corrected for multiple testing.ResultsThe response rate was 32.6%, similar to the survey in 2010 (34.4%). 88.1% agreed with the clinical relevance of adhesions, comparable to 2010 (89.8%). The score on the knowledge test was 38.8% (2010: 37.2%). Involvement of adhesion-related complications in the informed consent process increased, although 32.5% almost never mentions adhesions. In 2016, 42.4% reported a correct occurrence of bowel lesions during adhesiolysis, higher than in 2010 (P<0.001).ConclusionsThe adhesion awareness did not increase in six years, despite the efforts made. However, an increased awareness regarding adhesiolysis related complications was detected. Improvement of knowledge and behavior is essential to narrowing the gap between the impact of adhesions as a major complication of abdominal surgery and the limited adhesion awareness.

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“…SBO is a well-described complication after abdominal surgery and adhesion is considered as the cause of almost 75% SBO, other etiologies including IH, inguinal hernia, incisional hernia, and obstructive tumor etc 30 .…”

Section: Discussionmentioning

confidence: 99%

Closure of Petersen's defect in gastrectomy for gastric cancer: an interrupted time-series analysis from a high-volume institution in China

Wang

Chen

et al. 2020

Preprint

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Background Internal hernia (IH) and small bowel obstruction (SBO) are serious complications after gastrectomy for gastric cancer. Whether closure of Petersen's defect (PD) might reduce the rates is unknown. Methods Patients underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without closure of PD (non-closure group). From February 2017 to June 2018, we closed PD (closure group). The rates of IH, suspected internal hernia (SIH), and SBO were compared between the two groups. Results Among a total of 1213 patients, 151 patients (12.4%) developed SBO after gastrectomy, 10 patients (0.8%) developed IH and 20 patients (1.6%) developed SIH. The rate of SBO and SIH were 15.0% (124/828) and 2.3% (19/828) respectively in the non-closure group, compared with 7.0% (27/385) and 0.3% (1/385) in the closure group (p = 0.017 and p = 0.015 respectively). The rate of IH in the closure group (1/385, 0.3%) was lower than the non-closure group (9/828, 1.1%). Non-closure of PD was a risk factor for IH and SIH [odds ratio (OR) 6.58, 95%CI 1.56–27.85, p = 0.011]. Conclusions Closure of PD is recommended after gastrectomy, as we noticed a significantly lower rate of SBO and SIH, and a tendency for lower rate of IH.

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Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

Cited by 16 publications

References 29 publications

Risk factors for small bowel obstruction after open rectal cancer resection

Risk factors for small bowel obstruction after open rectal cancer resection

Adhesion awareness in 2016: An update of the national survey of surgeons

Closure of Petersen's defect in gastrectomy for gastric cancer: an interrupted time-series analysis from a high-volume institution in China

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