A recommendation for primary operative management for low adhesive bowel obstruction

Abstract

Background : Our patients who required surgery for adhesive small bowel obstruction (ASBO) were noticed to have a peculiar association. This link was the type of surgery they had originally, operations in the pelvis or those in which the scars were below the umbilicus. These patients did not improve on conservative management. This study was then undertaken to investigate this trend and to recommend primary surgery for these group of patients, terming them as low ASBO for the purpose of the study. Aims : (1) To show that majority of patients with low adhesive bowel obstruction do not get better on conservative management. (2) To propose surgical operation as the primary management strategy of patients with low adhesive bowel obstruction. Settings and Design : The study is set in the gastrointestinal surgery unit of the University College Hospital (UCH) Ibadan. The hospital is located in Ibadan, the most populous city in West Africa with a population of roughly 2.5 million inhabitants. The UCH Ibadan handles more than 90% of all surgical cases in Ibadan. Materials and Methods : This is a retrospective descriptive study from April 2003 to February 2010 conducted on patients who were admitted on the service of the gastrointestinal surgery unit of the UCH Ibadan, Nigeria, with a diagnosis of ASBO and had surgery for relief of the condition. Admission records, operations registers, and patients' case files were used in sourcing the data. Demographic indices such as age, sex, and type of previous operation were taken into account. Statistical Analysis : Stata 11.0 statistical software was used. Results : There were 4 male and 17 female patients giving a male: female ratio of roughly 1:4. Their ages ranged from 23 to 60 years. The global mean age was 40 years. The mean age for males was 31.5 years while for the female patients it was 42 years. Previous surgical operations showed that gynecological operations were in the majority (62%), followed by appendicectomy (24%) and colorectal surgery made up the rest (14%). Statistically, female sex, gynecological operations, and Lanz incisions for appendicectomy increase the chances of having surgery to relieve ASBO. Conclusions : We propose primary surgical treatment for low ASBO, especially those from gynecological operations and appendicectomy. Conservative management should be reserved as the initial treatment of non-low-level ASBO until other features prove otherwise.