Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review

Nieuwenhuijzen, Marieke E. van de; Reijnen, Michel M.P.J.; Kuijpers, J. H. C.; Goor, Harry van

doi:10.1046/j.1365-2168.1998.00841.x

Cited by 110 publications

(63 citation statements)

References 17 publications

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“…Unlike other postoperative complications, such as wound infection or anastomotic leakage, the consequences of adhesion formation comprise a lifelong risk for various clinical entities. [1][2][3][4][5][6] Patients with adhesion related complications are often treated by specialists other than the surgeon who did the first operation. The first surgeon therefore remains unaware of the complication, which might explain the gross underestimation of adhesion related complications among surgeons and gynaecologists.…”

Section: Introductionmentioning

confidence: 99%

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

Broek

Issa

Santbrink

et al. 2013

BMJ

464

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: Introductionmentioning

confidence: 99%

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

Broek

Issa

Santbrink

et al. 2013

BMJ

464

291

View full text Add to dashboard Cite

show abstract

“…There is general agreement that adhesions are a consequence of abdominal and pelvic surgery with a postoperative incidence of up to 90% [4]. Adhesions are known to be responsible for chronic pain associated with markedly reduced quality of life and are the most frequent cause for secondary female infertility [5,6,7,8,9,10,11]. Sixty to seventy percent of bowel obstructions are due to adhesions, associated with a mortality rate of 4.3-13% [8].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of 4DryField® PH as Adhesion Prevention Barrier Tested in an Optimized Adhesion Model in Rats

Poehnert¹,

Abbas

Kreipe

et al. 2015

Eur Surg Res

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Background: Adhesions due to pelvic/abdominal surgery are a common serious pathology possibly entailing severe complications. This study investigates the adhesion prevention capability of the novel starch-based agent 4DryField® PH, which together with saline solution forms a barrier gel. Herein, an optimized adhesion model (OPAM) inducing severe adhesions/agglutinations with high reproducibility was used. Methods: In 19 Lewis rats, a 1 × 2 cm abdominal wall defect was created, the peritoneum of the neighboring cecum was abraded, and both injured areas were approximated by suture. Rats were randomized to control (n = 10) or 4DryField PH treatment (n = 9) groups. Another 8 rats had sham surgery for safety assessment of 4DryField PH. At day 7, the quantity and quality of adhesions were assessed macro-/microscopically and evaluated statistically. Results: 4DryField PH treatment significantly reduced the incidence and severity of adhesions as verified by significantly improved adhesion scorings (0.4 vs. 4.5; 1.1 vs. 9). Histology revealed reconstitution of the cecum and abdominal wall including regeneration of the visceral/parietal peritoneum. In sham-operated rats, 4DryField PH did not induce adhesion formation. Conclusions: 4DryField PH gel was highly effective in preventing adhesions. Histologically, the injured cecum and abdominal wall regenerated well in the presence of 4DryField PH. Considering the severity of OPAM trauma, the potential of 4DryField PH to prevent adhesions can be rated excellent.

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“…Long-term results were not the aim of this study. Given the described high incidence of small bowel obstruction after open STC of up to 24% [28], we can speculate that for this specific long-term complication, an advantage can be expected, especially in young patients with IBD anticipating potential future surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and Open Subtotal Colectomies Have Similar Short-Term Results

Hoogenboom

Bosker

Groen³

et al. 2013

Dig Surg

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Background: Laparoscopic subtotal colectomy (STC) is a complex procedure. It is possible that short-term benefits for segmental resections cannot be attributed to this complex procedure. This study aims to assess differences in short-term results for laparoscopic versus open STC during a 15-year single-institute experience. Methods: We reviewed consecutive patients undergoing laparoscopic or open elective or subacute STC from January 1997 to December 2012. Results: Fifty-six laparoscopic and 50 open STCs were performed. The operation time was significantly longer in the laparoscopic group, median 266 min (range 121-420 min), compared to 153 min (range 90-408 min) in the open group (p < 0.001). Median hospital stay showed no statistical difference, 14 days (range 1-129 days) in the laparoscopic and 13 days (range 1-85 days) in the open group. Between-group postoperative complications were not statistically different. Conclusions: Laparoscopic STC has short-term results similar to the open procedure, except for a longer operation time. The laparoscopic approach for STC is therefore only advisable in selected patients combined with extensive preoperative counseling.

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Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review

Abstract: The incidence of SBO after colectomy is high. Colectomy may be a suitable model for studies of adhesion prevention.

Cited by 110 publications

References 17 publications

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

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

Evaluation of 4DryField® PH as Adhesion Prevention Barrier Tested in an Optimized Adhesion Model in Rats

Laparoscopic and Open Subtotal Colectomies Have Similar Short-Term Results

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