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Walshaw J, Smith HG, Lee MJ. Small bowel obstruction. Br J Surg 2024; 111:znae167. [PMID: 39041721 DOI: 10.1093/bjs/znae167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/16/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Josephine Walshaw
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, UK
| | - Henry G Smith
- Abdominalcenter K, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Matthew J Lee
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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2
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Wang H, Zhang JR, Tu PS, Chen WX, Chen S, Chen QF, Weng ZQ, Shang-Guan XC, Lin BQ, Chen XQ. Comparison of the effect between traditional conservation and nasointestinal tube placement in adhesive small bowel obstruction: A matched case-control study. Asian J Surg 2024; 47:2168-2177. [PMID: 38461140 DOI: 10.1016/j.asjsur.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/11/2024] Open
Abstract
Adhesive small bowel obstruction (ASBO) causes a major burden in emergency medicine. Owing to in situ decompression, nasointestinal tube (NIT) placement has been increasingly used in clinical practice compared with traditional conservation (TC); however, the indications remain controversial. This study was designed to explore the indications for each treatment in ASBOs and then suggest the optimal strategy. After propensity score matching, 128 pairs were included (the NIT and TC groups). The occurrence of severe adverse events (SAEs), peri-treatment clinical parameters, and radiological features were compared between the successful and failed treatment groups. According to different stages of the entire treatment, the independent risk factors for adverse effects for ASBO were analysed in phase I and phase II. In phase I, normal red blood cells (RBC) levels (p = 0.011) and a balanced sodium ion level (p = 0.016) positively affected the outcomes of TC treatment. In phase II, for the TC group, the successful treatment rate reached 79.5% for patients with ASBOs whose normal RBC levels (p = 0.006) or decreasing white blood cells (WBC) levels (p = 0.014) after treatment. For the NIT group, the treatment success rate was 68.1% for patients whose electrolyte imbalance could be reversed or whose neutrophil count/lymphocyte ratio (NLR) levels was lower than 4.3 (p = 0.018). TC treatment is highly recommended for patients with normal RBC counts and sodium levels pretreatment. After dynamic monitoring of the treatment process, for both the TC and NIT groups, once ASBOs had elevated inflammatory biomarkers or irreversible electrolyte disturbances, surgical interference was preferred.
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Affiliation(s)
- Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jun-Rong Zhang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Peng-Sheng Tu
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Wen-Xuan Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Qing-Feng Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zong-Qi Weng
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xin-Chang Shang-Guan
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Bing-Qiang Lin
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xian-Qiang Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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3
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Rashid A, Kumar M, Lee MJ. A systematic review of participant descriptors reported in studies of adhesive small bowel obstruction. Colorectal Dis 2024; 26:851-870. [PMID: 38609340 DOI: 10.1111/codi.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 11/05/2023] [Indexed: 04/14/2024]
Abstract
AIM Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO. METHOD This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team. RESULTS Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study. CONCLUSION There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.
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Affiliation(s)
- Adil Rashid
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Mithun Kumar
- Department of General Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
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4
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Symer MM, Zheng X, Pua BB, Sedrakyan A, Milsom JW. Contemporary Assessment of Adhesiolysis and Resection for Adhesive Small Bowel Obstruction in the State of New York. Surg Innov 2024:15533506241240580. [PMID: 38498843 DOI: 10.1177/15533506241240580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Adhesive small bowel obstruction (aSBO) is a common surgical problem, with some advocating for a more aggressive operative approach to avoid recurrence. Contemporary outcomes in a real-world setting were examined. STUDY DESIGN A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative database to identify adults admitted with aSBO, 2016-2020. Patients were stratified by the presence of inflammatory bowel disease (IBD) and cancer history. Diagnoses usually requiring resection were excluded. Patients were categorized into four groups: non-operative, adhesiolysis, resection, and 'other' procedures. In-hospital mortality, major complications, and odds of undergoing resection were compared. RESULTS 58,976 patients were included. 50,000 (84.8%) underwent non-operative management. Adhesiolysis was the most common procedure performed (n = 4,990, 8.46%), followed by resection (n = 3,078, 5.22%). In-hospital mortality in the lysis and resection groups was 2.2% and 5.9% respectively. Non-IBD patients undergoing operation on the day of admission required intestinal resection 29.9% of the time. Adjusted odds of resection were highest for those with a prior aSBO episode (OR 1.29 95%CI 1.11-1.49), delay to operation ≥3 days (OR1.78 95%CI 1.58-1.99), and non-New York City (NYC) residents being treated at NYC hospitals (OR1.57 95%CI 1.19-2.07). CONCLUSION Adhesiolysis is currently the most common surgery for aSBO, however nearly one-third of patients will undergo a more extensive procedure, with an increased risk of mortality. Innovative therapies are needed to reduce the risk of resection.
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Affiliation(s)
- Matthew M Symer
- Department of Surgery, Division of Colon and Rectal Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bradley B Pua
- Department of Radiology, Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey W Milsom
- Department of Surgery, Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Mortensen MR, Alouda M, Bond Z, Burcharth J, Finne KF, Jensen TK, Lolle I, Malik T, Ngo-Stuyt L, Nielsen LBJ, Olausson M, Skovsen AP, Tolver MA, Smith HG. One-year outcomes following operative or non-operative management of adhesional small bowel obstruction. BJS Open 2023; 7:zrad103. [PMID: 37837353 PMCID: PMC10576245 DOI: 10.1093/bjsopen/zrad103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND A trial of initial non-operative management is recommended in stable patients with adhesional small bowel obstruction. However, recent retrospective studies have suggested that early operative management may be of benefit in reducing subsequent recurrences. This study aimed to compare recurrence rates and survival in patients with adhesional small bowel obstruction treated operatively or non-operatively. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark, including consecutive patients admitted with adhesional small bowel obstruction over a 4-month interval. Patients were stratified into two groups according to their treatment (operative versus non-operative) and followed up for 1 year after their index admission. Primary outcomes were recurrence of small bowel obstruction and overall survival within 1 year of index admission. RESULTS A total of 201 patients were included, 118 (58.7 per cent) of whom were treated operatively during their index admission. Patients undergoing operative treatment had significantly better 1-year recurrence-free survival compared with patients managed non-operatively (operative 92.5 per cent versus non-operative 66.6 per cent, P <0.001). However, when the length of index admission was taken into account, patients treated non-operatively spent significantly less time admitted to hospital in the first year (median 3 days non-operative versus 6 days operative, P <0.001). On multivariable analysis, operative treatment was associated with decreased risks of recurrence (HR 0.22 (95 per cent c.i. 0.10-0.48), P <0.001) but an increased all-cause mortality rate (HR 2.48 (95 per cent c.i. 1.13-5.46), P = 0.024). CONCLUSION Operative treatment of adhesional small bowel obstruction is associated with reduced risks of recurrence but increased risk of death in the first year after admission. REGISTRATION NUMBER NCT04750811 (http://www.clinicaltrials.gov).prior (registration date: 11 February 2021).
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Affiliation(s)
- Marie R Mortensen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mohammad Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zara Bond
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Katrine F Finne
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Thomas K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ida Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Talha Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - Loan Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Liv B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Anders P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Mette A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Henry G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
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6
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Nielsen LBJ, Ærenlund MP, Alouda M, Azzam M, Bjerke T, Burcharth J, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Malik T, Ngo-Stuyt L, Nielsen EØ, Olausson M, Skovsen AP, Tolver MA, Smith HG. Real-world accuracy of computed tomography in patients admitted with small bowel obstruction: a multicentre prospective cohort study. Langenbecks Arch Surg 2023; 408:341. [PMID: 37642708 PMCID: PMC10465641 DOI: 10.1007/s00423-023-03084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Small bowel obstruction (SBO) is a common surgical emergency. Previous studies have shown the value computed tomography (CT) scanning in both confirming this diagnosis and identifying indications for urgent surgical intervention, such as strangulated bowel or closed loop obstructions. However, most of the literature is based on retrospective expert review of previous imaging and little data regarding the real-time accuracy of CT reporting is available. Here, we investigated the real-world accuracy of CT reporting in patients admitted with SBO. METHODS This was a multicentre prospective study including consecutive patients admitted with SBO. The primary outcomes were the sensitivity and specificity of CT scanning for bowel obstruction with ischaemia and closed loop obstruction. Data were retrieved from the original CT reports written by on-call radiologists and compared with operative findings. RESULTS One hundred seventy-six patients were included, all of whom underwent CT scanning with intravenous contrast followed by operative management of SBO. Bowel obstruction with ischaemia was noted in 20 patients, with a sensitivity and specificity of CT scanning of 40.0% and 85.5%, respectively. Closed loop obstructions were noted in 26 patients, with a sensitivity and specificity of CT scanning of 23.1% and 98.0%, respectively. CONCLUSIONS The real-world accuracy of CT scanning appears to be lower than previously reported in the literature. Strategies to address this could include the development of standardised reporting schemas and to increase the surgeon's own familiarity with relevant CT features in patients admitted with SBO.
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Affiliation(s)
- L B J Nielsen
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - M P Ærenlund
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - J Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Olausson
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - H G Smith
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.
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Carmichael SP, Kline DM, Mowery NT, Miller PR, Meredith JW, Hanchate AD. Geographic Variation in Operative Management of Adhesive Small Bowel Obstruction. J Surg Res 2023; 286:57-64. [PMID: 36753950 PMCID: PMC10034859 DOI: 10.1016/j.jss.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/06/2022] [Accepted: 12/25/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Variation in surgical management exists nationally. We hypothesize that geographic variation exists in adhesive small bowel obstruction (aSBO) management. MATERIALS AND METHODS A retrospective analysis of a national commercial insurance claims database (MarketScan) sample (2017-2019) was performed in adults with hospital admission due to aSBO. Geographic variation in rates of surgical intervention for aSBO was evaluated by state and compared to a risk-adjusted national baseline using a Bayesian spatial rates Poisson regression model. For individual-level analysis, patients were identified in 2018, with 365-d look back and follow-up periods. Logistic regression was performed for individual-level predictors of operative intervention for aSBO. RESULTS Two thousand one hundred forty-five patients were included. State-level analysis revealed rates of operative intervention for aSBO were significantly higher in Missouri and lower in Florida. On individual-level analysis, age (P < 0.01) and male sex (P < 0.03) but not comorbidity profile or prior aSBO, were negatively associated with undergoing operative management for aSBO. Patients presenting in 2018 with a history of admission for aSBO the year prior experienced a five-fold increase in odds of representation (odds ratio: 5.4, 95% confidence interval: 3.1-9.6) in 2019. Patients who received an operation for aSBO in 2018 reduced the odds of readmission in the next year by 77% (odds ratio: 0.23, 95% confidence interval: 0.1-0.5). The volume of operations performed within a state did not influence readmission. CONCLUSIONS Surgical management of aSBO varies across the continental USA. Operative intervention is associated with decreased rates of representation in the following year. These data highlight a critical need for standardized guidelines for emergency general surgery patients.
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Affiliation(s)
- Samuel P Carmichael
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
| | - David M Kline
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Nathan T Mowery
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Preston R Miller
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - J Wayne Meredith
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Amresh D Hanchate
- Division of Public Health Sciences, Department of Social Science and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
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Chen B, Sheng WY, Ma BQ, Mei BS, Xiao T, Zhang JX. Progress in diagnosis and treatment of surgery-related adhesive small intestinal obstruction. Shijie Huaren Xiaohua Zazhi 2022; 30:1016-1023. [DOI: 10.11569/wcjd.v30.i23.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Adhesive small bowel obstruction is a relatively common surgical acute abdomen, which is caused by various factors that result in the contents of the small bowel failing to pass smoothly. The clinical symptoms include abdominal pain, distension, nausea and vomiting, and defecation disorder. The chance of adhesive small bowel obstruction to develop in patients with a history of abdominal surgery is around 2.4%. This paper discusses the most recent developments in the conservative and surgical management of adhesive small bowel obstruction based on clinical manifestation, laboratory analysis, and imaging examination.
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Affiliation(s)
- Biao Chen
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Wei-Yong Sheng
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bing-Qing Ma
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bo-Sheng Mei
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Tian Xiao
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jin-Xiang Zhang
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Olausson M, Aerenlund MP, Azzam M, Bjerke T, Burcharth JFH, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Ngo-Stuyt L, Nielsen EØ, Nielsen LBJ, Skovsen AP, Tolver MA, Smith HG. Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study. Eur J Trauma Emerg Surg 2022; 49:1121-1130. [PMID: 36357790 PMCID: PMC9648885 DOI: 10.1007/s00068-022-02171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Abstract
AIMS The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates. RESULTS 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%. CONCLUSIONS The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations. TRIAL REGISTRATION Trial registration number: NCT04750811. Trial registration date: 11/02/2021.
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Affiliation(s)
- M Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - M P Aerenlund
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J F H Burcharth
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - H G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
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10
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Podda M, Khan M, Di Saverio S. Adhesive Small Bowel Obstruction and the six w's: Who, How, Why, When, What, and Where to diagnose and operate? Scand J Surg 2021; 110:159-169. [PMID: 33511902 DOI: 10.1177/1457496920982763] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
- M Podda
- Department of Emergency Surgery, Policlinico Universitario "Duilio Casula," Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - M Khan
- Department of General and Trauma Surgery, Brighton and Sussex University Hospital NHS Trust, Brighton, UK
| | - S Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Varese, Italy
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Behman R, Nathens AB, Pechlivanoglou P, Karanicolas P, Jung J, Look Hong N. Early operative management in patients with adhesive small bowel obstruction: population-based cost analysis. BJS Open 2020; 4:914-923. [PMID: 32603528 PMCID: PMC7528511 DOI: 10.1002/bjs5.50311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Adhesive small bowel obstruction (aSBO) is a potentially recurrent disease. Although non‐operative management is often successful, it is associated with greater risk of recurrence than operative intervention, and may have greater downstream morbidity and costs. This study aimed to compare the current standard of care, trial of non‐operative management (TNOM), and early operative management (EOM) for aSBO. Methods Patients admitted to hospital between 2005 and 2014 in Ontario, Canada, with their first episode of aSBO were identified and propensity‐matched on their likelihood to receive EOM for a cost–utility analysis using population‐based administrative data. Patients were followed for 5 years to determine survival, recurrences, adverse events and inpatient costs to the healthcare system. Utility scores were attributed to aSBO‐related events. Cost–utility was presented as the incremental cost‐effectiveness ratio (ICER), expressed as Canadian dollars per quality‐adjusted life‐year (QALY). Results Some 25 150 patients were admitted for aSBO and 3174 (12·6 per cent) were managed by EOM. Patients managed by TNOM were more likely to experience recurrence of aSBO (20·9 per cent versus 13·2 per cent for EOM; P < 0·001). The lower recurrence rate associated with EOM contributed to an overall net effectiveness in terms of QALYs. The mean accumulated costs for patients managed with EOM exceeded those of TNOM ($17 951 versus $11 594 (€12 288 versus €7936) respectively; P < 0·001), but the ICER for EOM versus TNOM was $29 881 (€20 454) per QALY, suggesting cost‐effectiveness. Conclusion This retrospective study, based on administrative data, documented that EOM may be a cost‐effective approach for patients with aSBO in terms of QALYs. Future guidelines on the management of aSBO may also consider the long‐term outcomes and costs.
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Affiliation(s)
- R Behman
- Division of General Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - A B Nathens
- Division of General Surgery, Department of Surgery, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - P Pechlivanoglou
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - P Karanicolas
- Division of General Surgery, Department of Surgery, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - J Jung
- Division of General Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - N Look Hong
- Division of General Surgery, Department of Surgery, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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