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

BJS Open ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. 30-38 ◽  
Author(s):  
P. Andersen ◽  
K. K. Jensen ◽  
R. Erichsen ◽  
T. Frøslev ◽  
P.-M. Krarup ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cohort Study ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Population Based ◽  
Adhesive Small Bowel Obstruction ◽  
Cancer Resection ◽  
Rectal Cancer Resection

scholarly journals Risk factors for small bowel obstruction after open rectal cancer resection

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kevin Afshari ◽  
Abbas Chabok ◽  
Kenneth Smedh ◽  
Maziar Nikberg
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Rectal Resection ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Cancer Resection ◽  
Rectal Cancer Resection

Abstract 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.

scholarly journals Early operative management in patients with adhesive small bowel obstruction: population‐based cost analysis

BJS Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. 914-923
Author(s):  
R. Behman ◽  
A. B. Nathens ◽  
P. Pechlivanoglou ◽  
P. Karanicolas ◽  
J. Jung ◽  
...  
Keyword(s):  
Small Bowel ◽  
Cost Analysis ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Operative Management ◽  
Population Based ◽  
Adhesive Small Bowel Obstruction

Evolving Management Strategies in Patients with Adhesive Small Bowel Obstruction: a Population-Based Analysis

2018 ◽  
Vol 22 (12) ◽  
pp. 2133-2141 ◽  
Author(s):  
Ramy Behman ◽  
Avery B. Nathens ◽  
Nicole Look Hong ◽  
Petros Pechlivanoglou ◽  
Paul J Karanicolas
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Management Strategies ◽  
Population Based ◽  
Adhesive Small Bowel Obstruction

scholarly journals Mechanisms of adhesive small bowel obstruction and outcome of surgery; a population-based study

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Thorbjörn Sakari ◽  
Malin Christersson ◽  
Urban Karlbom
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Operation Time ◽  
Population Based ◽  
Adhesive Small Bowel Obstruction ◽  
Population Based Study ◽  
American Society ◽  
Complications And Mortality

Abstract Background This study aims to describe the mechanisms of adhesive small bowel obstruction (SBO) and its morbidity, mortality and recurrence after surgery for SBO in a defined population. Method Retrospective study of 402 patients (240 women, median age 70 years, range 18–97) who underwent surgery for SBO in the Uppsala and Gävleborg regions in 2007–2012. Patients were followed to last note in medical records or death. Result The cause of obstruction was a fibrous band in 56% and diffuse adhesions in 44%. Early overall postoperative morbidity was 48 and 10% required a re-operation. Complications, intensive care and early mortality (n = 21, 5.2%) were related to age (p < 0.05) and American Society of Anesthesiologist’s class (p < 0.01). At a median follow-up of 66 months (0–122), 72 patients (18%) had been re-admitted because of SBO; 26 of them underwent a re-operation. Previous laparotomies (p = 0.013), diffuse adhesions (p = 0.050), and difficult surgery (bowel injury, operation time and bleeding, p = 0.034–0.003) related to recurrent SBO. The cohort spent 6735 days in hospital due to SBO; 772 of these days were due to recurrent SBO. In all, 61% of the cohort was alive at last follow-up. Late mortality was related to malignancies, cardiovascular disease, and other chronic diseases. Conclusions About half of patients with SBO are elderly with co-morbidities which predispose to postoperative complications and mortality. Diffuse adhesions, which make surgery difficult, were common and related to future SBO. Overall, nearly one-fifth of patients needed re-admission for recurrent SBO. Continued research for preventing SBO is desirable. Trial registration The study was registered at ClinicalTrials.gov (NCT03534596, retrospectively registered, 2018-05-24).

Adhesive Small Bowel Obstruction Protocol in Geriatric Patients

2019 ◽  
Vol 229 (4) ◽  
pp. S87
Author(s):  
Jose A. Aldana ◽  
Javier E. Rincon ◽  
Ricardo A. Fonseca ◽  
Rohit K. Rasane ◽  
Christina X. Zhang ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Geriatric Patients ◽  
Adhesive Small Bowel Obstruction

scholarly journals Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021 ◽  
pp. 145749692098276
Author(s):  
M. Podda ◽  
M. Khan ◽  
S. Di Saverio
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Bowel Ischemia ◽  
Current Evidence ◽  
First Episode ◽  
Adhesive Small Bowel Obstruction ◽  
Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

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