This article is more than 5 years old. Information may no longer be current.
Adhesive small bowel obstruction surgery reduces recurrence risk
Click Here to Manage Email Alerts
Surgical intervention for a patient’s first occurrence of adhesive small bowel obstruction significantly reduced the risk for recurrence, according to results of a longitudinal, retrospective cohort study. This finding challenges the current standard of care, in which surgical intervention was thought to raise the risk for recurrence.
“Small bowel obstruction is one of the most common reasons for admission to hospital in developed countries yet is extremely under-studied,” Ramy Behman, MD, PhD, a general surgery resident at University of Toronto, told Healio Gastroenterology and Liver Disease. “We know that small bowel obstruction is a recurrent problem in many patients, however the lack of studies that examined long-term outcomes has limited our understanding of this disease. We sought to better understand how different management strategies for adhesive bowel obstruction impact long-term outcomes, specifically, the risk of recurrence.”
The retrospective, population-based study included patients who were admitted to the hospital in Ontario for their first occurrence of adhesive small bowel obstruction (aSBO). The researchers then compared the rate of recurrence of aSBO between patients who were treated operatively and those who did not undergo surgery.
The cumulative incidence of aSBO recurrence after the initial hospital admission served as the primary endpoint. The incidence of additional recurrences after a patients’ second episode of aSBO served as a secondary endpoint.
Researchers included adults aged 18 to 80 years who were admitted to the hospital from April 2005 through March 2014 with a primary diagnosis of adhesive intestinal obstruction (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code K56.5) or unspecified intestinal obstruction (ICD-10 code K56.6).
During the study period, 27,904 patients (mean age, 61.2 years; 51% female) were admitted to the hospital with their first episode of aSBO.
Ten years was the maximum follow-up after the initial admission for aSBO.
Less than one-quarter (n = 6,186) underwent surgery at their initial admission to the hospital. The probability of being treated surgically decreased with each episode from 22.2% of patients admitted for their index episode of aSBO to 16.6% of patients admitted for their second episode.
Overall, 19.6% of patients (95% CI, 19.2%-20.1%) experienced at least one admission for recurrence of aSBO during the study period. The probability of a subsequent recurrence increased from 36.5% after the first recurrence to 63.5% after the seventh recurrence.
Patients who underwent surgery during their initial aSBO admission had a decreased overall risk for recurrence compared with those who did not undergo surgery (13% vs. 21.3%; P < .001). Five-year cumulative incidence of recurrence was also significantly lower among patients undergoing surgery (11.2% vs. 19.2%; P < .001).
There was an increase in 5-year probability of recurrence associated with each additional episode of aSBO that was not treated with surgery.
The 5-year probability of recurrence ranged from 19.2% (95% CI, 18.1%-20.1%) after the first episode to 48% (95% CI, 43%-53%) after the third episode.
Surgery during the second episode was associated with a significantly lower risk for subsequent recurrence than nonsurgical methods (19.3% vs 39.2%; 95% CI, 34%-63%).
Behman said that there has traditionally been a belief that surgical intervention for the treatment of aSBO increases the risk for recurrence through the creation of new adhesions. However, he noted that he hopes these results help to change that perception.
“This dogma has informed the most current guidelines and the current standard of care of a trial of non-operative management,” he said. “These guidelines approach the disease as though it is defined by acute, independent episodes, rather than a potentially long-term recurrent illness. The findings of this study significantly challenge surgical dogma and alter the way that we understand and think about this extremely common disease. We expect that our findings will challenge the current standard of care and will alter the way that this disease is managed.”
Behman added that the hope is that the study results will help change the way clinicians understand and approach aSBO.
“We hope that by better understanding its natural history, clinicians will view it as a long-term recurrent illness characterized by recurrences and that the natural history of this disease can be significantly altered through operative intervention,” he said. – by Ryan McDonald
Disclosures: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts