Recurrence After Operative Treatment of Adhesive Small-Bowel Obstruction

Lorentzen, Lea; Øines, Mari Nanna; Oma, Erling; Jensen, Kristian K.; Jørgensen, Lars N.

doi:10.1007/s11605-017-3604-x

Cited by 14 publications

(17 citation statements)

References 14 publications

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“…To our knowledge, this has not been reported previously. Lorentzen et al recently found that female gender is associated with increased risk for recurrence of adhesions after surgery for ASBO [ 21 ]. These findings indicate that the impact of gender on the formation of adhesions needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Band adhesions not related to previous abdominal surgery – A retrospective cohort analysis of risk factors

Skoglar

Gunnarsson

Falk

2018

Annals of Medicine and Surgery

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BackgroundPostoperative intra-abdominal adhesion formation is a common cause of small bowel obstruction (SBO). Adhesions causing SBO are classed as either matted adhesions or solitary band adhesions. The aim of this study was to investigate the prevalence of previous abdominal surgery in a cohort of patients operated for bowel obstruction and to analyze the causes of obstruction discovered at surgery.Materials and methodsThe study was performed at a county hospital with a catchment population of 120 000 inhabitants. Records of operations performed for bowel obstruction over a period of 70 months were retrieved.ResultsOf the 196 surgical procedures for intestinal obstruction included, 108 (55%) were caused by adhesions. In this group, 42 (39%) were due to solitary band adhesions and 66 (61%) were due to matted adhesions. Ten of 18 male patients (56%) with a solitary obstructing band had not undergone previous abdominal surgery (p < 0.05). In the cohort as a whole, a significant number of surgical procedures were performed for solitary band adhesions in patients without prior history of surgery (p < 0.01).ConclusionIn male patients, not only previous abdominal surgery but also other factors appear to increase the risk for bowel obstruction due to a solitary band. For intestinal obstruction caused by matted adhesions, however, previous abdominal surgery is the main risk factor in both genders. Patients with signs of SBO but without previous abdominal surgery should be managed bearing in mind that solitary band adhesion and thereby strangulation may be present regardless of previous surgery or not.

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Section: Discussionmentioning

confidence: 99%

“…Comparison with other studies is difficult due to differences in inclusion criteria. An overview of studies with inclusion criteria similar to ours is presented in Table 3 [ 1 , 15 , [19] , [20] , [21] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ].…”

Section: Discussionmentioning

confidence: 99%

Band adhesions not related to previous abdominal surgery – A retrospective cohort analysis of risk factors

Skoglar

Gunnarsson

Falk

2018

Annals of Medicine and Surgery

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“…[ 18 ] Lorentzen et al reported that the overall recurrence rate after surgically treated ASBO was 12.1%, and the risk factors for recurrence were female sex, multiple/matted adhesions, and fascial dehiscence. [ 3 ]…”

Section: Discussionmentioning

confidence: 99%

“…Operative management can lead to the formation of new adhesions, which in turn can contribute to recurrence. [ 3 , 4 ] Therefore, the treatment methods (operative or conservative) may influence the risk of recurrence. [ 5 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction

Mu¹,

Wang²,

Wang³

et al. 2018

Medicine

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Postoperative adhesions are a common cause of adhesive small bowel obstruction (ASBO), and recognition of intestinal strangulation is important. The aim of this study is to analyze the clinical factors for strangulating obstruction and to identify the predictors for recurrence of ASBO.A retrospective study was conducted using the database in our department. Patients with ASBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrence after treatment were analyzed by using univariate and multivariate logistic regression model.In total, 288 ASBO patients were included in the study. Of these, 37 (12.9%) patients had occurred strangulating obstructions, and 251 (87.1%) patients had simple obstructions. Four clinical parameters, including increasing heart rate (>100 bpm), increasing WBC count (>15 × 109/L), CT findings of thickening or swelling of the mesentery, and CT showing seroperitoneum were detected as independent clinical factors for intestinal strangulation. Eighty-four (29.2%) patients experienced recurrence of obstruction during the median 24 months of follow-up. Recurrence rates were reduced in patients who underwent surgical treatment compared with those who received conservative management [21.3% (26/122) vs 34.9% (58/166) (P = .010)]. Nevertheless, the recurrence rates were not significantly increased in patients with strangulating obstructions compared with those with simple ASBO [34.3% (12/35) vs 27.7% (72/253) (P = .186)].Four clinical parameters including tachycardia, leukocytosis, along with CT findings of thickening or swelling of the mesentery and CT showing seroperitoneum, associated with occurrence of intestinal strangulation in ASBO. ASBO patients who underwent surgical treatment had a reduced recurrence rate, but ASBO patients with strangulating obstructions had not increase the recurrence rates than those of patients with simple ASBO.

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“…In the absence of bowel ischemia, strangulation or perforation, current guidelines for the management of SBO are gastric decompression with suction, full strength gastrographin (in some institutions), and IV hydration for the first 24-72 h to see if the obstruction will resolve without surgery[ 10 ]. While sometimes effective in treating the current obstruction, this approach does not address the internal adhesions or the risk of subsequent bowel obstructions[ 11 , 12 ]. The only treatment currently available to reverse adhesive bowel obstructions is surgery, which frequently causes new adhesions.…”

Section: Introductionmentioning

confidence: 99%

Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study

Rice¹,

Patterson²,

Reed³

et al. 2018

WJG

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AIMTo compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment.METHODSOne hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.RESULTSDespite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved (P < 0.0001). The medication domain was not changed in the CPA treated group (P = 0.176).CONCLUSIONCPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.

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Recurrence After Operative Treatment of Adhesive Small-Bowel Obstruction

Abstract: The overall recurrence rate after surgically treated ASBO was 12.1%, and the risk of recurrence was persistent several years after index operation. Factors associated with an increased risk were female gender, multiple/matted adhesions, and fascial dehiscence.

Cited by 14 publications

References 14 publications

Band adhesions not related to previous abdominal surgery – A retrospective cohort analysis of risk factors

Band adhesions not related to previous abdominal surgery – A retrospective cohort analysis of risk factors

Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction

Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study

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