scholarly journals Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis

2018 ◽  
Vol 36 (3) ◽  
pp. 183-194 ◽  
Author(s):  
Rana Madani ◽  
Nigel Day ◽  
Lalit Kumar ◽  
Henry S. Tilney ◽  
Andrew Mark Gudgeon
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Anastomotic Leak ◽  
Bowel Obstruction ◽  
Group Performance ◽  
Bowel Resection ◽  
Loop Ileostomy ◽  
Complication Rates ◽  
Definitive Answer ◽  
Significant Difference

Background: Individual trials comparing hand-sewn with stapled closure of loop ileostomy show different outcomes due to lack of statistical power. A systematic review, with a pooled analysis of results, might provide a more definitive answer. This review aimed to compare hand-sewn with stapled anastomotic technique for closure of a loop ileostomy and looked at the effect of bowel resection on the complication rates. Methodology: Relevant studies were identified from MEDLINE, EMBASE and the Cochrane database. All randomised clinical trials, prospective and retrospective studies comparing hand-sewn with stapled closure of loop ileostomy were included. Results: Of the 4,917 patients in 15 identified studies, 3,406 had hand-sewn and 1,511 stapled anastomosis. There was no difference in the rate of anastomotic leak between the hand-sewn (2.93%, 55/1,877) and the stapled group (2.08%, 25/1,202) (OR 0.81, 95% CI 0.43–1.54, p = 0.52, I2 = 33%). The rate of small-bowel obstruction was higher in the hand-sewn group (7.03%, 231/3,284) compared to the stapled group (5.58%, 73/1,308; OR 0.69, 95% CI 0.51–0.92, p = 0.01, I2 = 0%). There was no difference in the incidence of anastomotic leak and small-bowel obstruction in the hand-sewn anastomosis between patients with or without bowel resection. Conclusions: There was no significant difference in the rate of anastomotic leakage between the hand-sewn and stapled techniques. The rate of small-bowel obstruction was higher in the hand-sewn group. Performance of bowel resection does not significantly increase the incidence of anastomotic leak or small-bowel obstruction.

scholarly journals Machine Learning Prediction of Surgical Intervention for Small Bowel Obstruction

2021 ◽  
Author(s):  
Miles Turpin ◽  
Joshua Watson ◽  
Matthew Engelhard ◽  
Ricardo Henao ◽  
David Thompson ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Prediction Models ◽  
Average Length ◽  
Discharge Rate ◽  
Health Care Expenditures ◽  
Inpatient Setting ◽  
Complication Rates ◽  
Model Based

Small bowel obstruction (SBO) results in >350,000 operations and >$2 billion annual health care expenditures in the US. Prompt, effective identification of patients at high/low surgery risk could improve survival, lower complication rates, and shorten hospitalization lengths. SBO surgery prediction models were developed based on SBO-related encounters in the Duke University Health System between 2013 and 2017. A total of 3,910 encounters among 3,374 unique patients were identified. Performance was assessed in each hour after admission when predicting whether patients will (a) receive surgery within 24 hours, and (b) receive surgery during the current encounter. Potential benefits of model-based discharge were assessed using the incorrect discharge rate and average reduction in hospital stay. Model-based discharge of low-risk patients was projected to reduce the average length of stay among patients not receiving surgery by >60 hours while maintaining an incorrect discharge rate lower than the observed readmission rate (9.3%). AUROC for the 24-hour prediction task increased from 0.644 to 0.779 at 12 and 72 hours post-admission, respectively. Future work will prospectively explore the benefits of model deployment in an inpatient setting.

scholarly journals Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction

2016 ◽  
Vol 10 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Glenn Harvin ◽  
Adam Graham
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Bowel Resection ◽  
Rare Complication ◽  
Small Bowel Resection ◽  
Sclerosing Mesenteritis ◽  
Exact Etiology ◽  
Resected Tissue ◽  
Uncommon Condition

Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction.

Small Bowel Obstruction by Wireless Enteroscopic Capsule and Unrecognized Intestinal Stricture

2006 ◽  
Vol 72 (12) ◽  
pp. 1216-1217
Author(s):  
Hadi Najafian ◽  
Camille Eyvazzadeh
Keyword(s):  
Small Bowel ◽  
Physical Examination ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Unusual Case ◽  
Bowel Resection ◽  
Anastomotic Stricture ◽  
History Of ◽  
Resection And Anastomosis

The wireless enteroscopy capsule (WEC) was approved for noninvasive visualization of small bowel. We report an unusual case of a previously healthy man with history of bowel resection and anastomosis who developed small bowel obstruction after ingestion of a WCE. At operation, an anastomotic stricture site was noted and the WEC was proximal to this stricture, causing obstruction. This case emphasizes the importance of a good history and physical examination, as well as vigilant follow-up and retrieval of WEC.

scholarly journals Development of a Web-Based Nonoperative Small Bowel Obstruction Treatment Pathway App

2020 ◽  
Vol 11 (04) ◽  
pp. 535-543
Author(s):  
Heather Lyu ◽  
Caitlin Manca ◽  
Casey McGrath ◽  
Jennifer Beloff ◽  
Nina Plaks ◽  
...  
Keyword(s):  
Small Bowel ◽  
Electronic Health Record ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Bowel Resection ◽  
Adhesive Small Bowel Obstruction ◽  
Evidence Based ◽  
Health Record ◽  
Time To Surgery ◽  
Electronic Health

Abstract Objective An electronic pathway for the management of adhesive small bowel obstruction (SBO) was built and implemented on top of the electronic health record. The aims of this study are to describe the development of the electronic pathway and to report early outcomes. Methods The electronic SBO pathway was designed and implemented at a single institution. All patients admitted to a surgical service with a diagnosis of adhesive SBO were enrolled. Outcomes were compared across three time periods: (1) patients not placed on either pathway from September 2013 through December 2014, (2) patients enrolled in the paper pathway from January 2017 through January 2018, and (3) patients enrolled in the electronic pathway from March through October 2018. The electronic SBO pathway pulls real-time data from the electronic health record to prepopulate the evidence-based algorithm. Outcomes measured included length of stay (LOS), time to surgery, readmission, surgery, and need for bowel resection. Comparative analyses were completed with Pearson's chi-squared, analysis of variance, and Kruskal–Wallis tests. Results There were 46 patients enrolled in the electronic pathway compared with 93 patients on the paper pathway, and 101 nonpathway patients. Median LOS was lower in both pathway cohorts compared with those not on either pathway (3 days [range 1–11] vs. 3 days [range 1–27] vs. 4 days [range 1–13], p = 0.04). Rates of readmission, surgery, time to surgery, and bowel resection were not significantly different across the three groups. Conclusion It is feasible to implement and utilize an electronic, evidence-based clinical pathway for adhesive SBOs. Use of the electronic and paper pathways was associated with decreased hospital LOS for patients with adhesive SBOs.

Small Bowel Obstruction: Outcome and Cost Implications of Admitting Service

2010 ◽  
Vol 76 (7) ◽  
pp. 687-691 ◽  
Author(s):  
Tolutope Oyasiji ◽  
Steve Angelo ◽  
Tassos C. Kyriakides ◽  
Scott W. Helton
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Bowel Resection ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
Operative Intervention ◽  
Hospital Charges ◽  
Gender And Race ◽  
Artery Disease

We compared patients with small bowel obstruction (SBO) admitted through the emergency department to the surgical service (SS) with those admitted to the medical service (MS) with respect to outcomes and healthcare cost. We conducted a retrospective analysis of our SBO database comparing 482 patients admitted to SS and 153 patients admitted to MS at a single institution over a 5-year period (January 2003 to December 2007). Study outcomes included length of hospital stay (LOS), time to surgery (TTS), hospital charges, incidence of bowel resection, and mortality. Both groups were comparable for age, gender, and race. The SS group had a shorter LOS (6.1 vs 7.5 days; P = 0.01), less hospital charges ($29,549 vs $35,789; P = 0.06), shorter TTS (log rank comparison; P = 0.006), and less mortality (eight [1.66%] vs six [3.92]; P = 0.11). The SS group had more bowel resections (13.1 vs 5.2%; P = 0.007). Coronary artery disease (CAD), acute renal failure (ARF), admission to SS, and female gender were significant predictors of bowel resection. CAD and ARF were significant predictors of mortality. Two hundred forty-four patients required operative intervention (surgery operative subgroup [SOS] 210 [43.6%], medicine operative subgroup [MOS] 34 [22.2%]). SOS and MOS were comparable for gender and race. SOS had shorter LOS (9.1 vs 12.3 days; P = 0.02), less hospital charges ($46,258 vs $62,778, P = 0.05), and less mortality (eight [3.81%] vs four [11.76%]; P = 0.07). Bowel resection was comparable (SOS 30% vs MOS 23%; P = 0.44). CAD and congestive heart failure (CHF) were significant predictors of bowel resection, whereas CAD was the only significant predictor of mortality in this subgroup. We recommend that patients with SBO be admitted to SS because this might translate to shorter LOS, earlier operative intervention, and reduced healthcare use direct cost. Bowel resection and death are more likely to occur in patients with comorbidities like CHF, CAD, diabetes mellitus, and ARF.

scholarly journals Clinical Analysis of the Curative Effect of a Transnasal Ileus Tube in the Treatment of Small Bowel Obstruction Caused by a Phytobezoar

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yong-Xu Lin ◽  
Sun-Jian Wang ◽  
Hui-Shun Liang ◽  
Su Lin ◽  
Li-Yong Bian ◽  
...  
Keyword(s):  
Small Bowel ◽  
Conservative Treatment ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Albumin Level ◽  
Tube Placement ◽  
Curative Effect ◽  
Duration Of Symptoms ◽  
Conservative Group ◽  
Significant Difference

Objective. To investigate the curative effect of a transnasal ileus tube in the treatment of small bowel obstruction caused by a phytobezoar. Methods. Seventy-one patients with small bowel obstruction caused by a phytobezoar who underwent treatment in three provincial tertiary grade A hospitals in Fujian Province from March 2011 to February 2020 were included in this study. Patients were divided into the following two groups according to the treatment received: (1) conservative group, comprising patients who received medical conservative treatment, and (2) combined group, including patients who received combined medical conservative treatment and transnasal ileus tube placement. The clinical symptoms, changes in abdominal imaging, tube depth of the first day, reduction of pressure volume on the first day after catheterization, length of hospital stay, and nonsurgical rate were compared between the combined and conservative groups. Results. There was no significant difference in age, sex, history of previous abdominal surgery and abdominal radiotherapy, symptoms at admission, duration of symptoms before admission, signs at admission, laboratory data, and obstruction position between the combined and conservative groups. There was a statistically significant difference in the nonsurgical rate (19/24 vs. 23/47, P = 0.014 ) between the combined and conservative groups. Logistic analysis showed that the duration of symptoms before admission, albumin level, and use of a transnasal ileus tube might be independent factors affecting the transition to surgery for patients with small bowel obstruction caused by a phytobezoar ( P < 0.05 ). Conclusion. Timely conservative medical treatment with transnasal ileus tube placement can effectively improve the nonsurgical rate of small bowel obstruction caused by a phytobezoar. The duration of symptoms before admission, albumin level, and use of a transnasal ileus tube were closely related to whether patients with small bowel obstruction caused by phytobezoar were transferred to surgery.

scholarly journals Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis

2018 ◽  
Vol 34 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Hitoshi Kameyama ◽  
Yoshifumi Hashimoto ◽  
Yoshifumi Shimada ◽  
Saki Yamada ◽  
Ryoma Yagi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Ileal Pouch ◽  
Loop Ileostomy ◽  
Ileal Pouch Anal Anastomosis ◽  
Anal Anastomosis
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