Risk Factors for the Development of Adhesive Small Bowel Obstruction after Abdominal and Pelvic Operations

Amit Sastry,I Michael Leitman,Maria Grigoreva

doi:10.4236/ojgas.2015.53003

Abstract

Introduction: Adhesive small bowel obstruction (SBO) is a disease process that has been difficult to prevent. Mechanical barriers and chemical agents exist to disrupt the formation of adhesions following surgery but each associated with medical risk and financial burden. Identifying risk factors for developing SBO in patients post laparotomy would aid in the appropriate use of such agents. We hypothesize that there might be additional risk factors that are associated with a higher likelihood of SBO. Methods: A retrospective analysis from 2008 to 2012 was performed. Cases of SBO following previous laparotomy were compared to those without SBO. Results: 468 medical records were reviewed (57% male). Operations that caused the highest risks for SBO included gynecological, colorectal and hernia operations with prosthetic materials. 66% percent of patients underwent a prior abdominal or pelvic high-risk procedure. The average time from surgery to the development of SBO was 24 months (median 19 months). Patients who developed SBO had a median age of 58.4 years on initial surgery, average previous operative time of 4.3 hours, and an av-erage of two prior operations. For every hour of operative time, the odds of developing SBO increased by 33% (p 3 decreased the odds of SBO (p = 0.05). Conclusions: Longer operative times are associated with post-operative adhesive small bowel obstruction. Patients with an ASA score greater than or equal to 3 appear to have a reduced risk of adhesive small bowel obstruction.

Highlights

Adhesive small bowel obstruction (SBO) is a disease process that has been difficult to prevent
The purpose of this study was to identify risk factors for the development of small bowel obstruction; this would assist in predicting who might be at higher risk for developing an Adhesive small bowel obstruction (ASBO) after laparotomy
Intra-abdominal adhesions are likely the result of the inflammatory response to operative injury and infection. These adhesions represent the effect of the imbalance between fibrin deposition and degradation [3] [4]. While they result in almost all patients after abdominal and pelvic operations, only a minority will develop symptoms and still fewer suffer the morbidity of intestinal obstruction [5]

Summary

Introduction

Adhesive small bowel obstruction (SBO) is a disease process that has been difficult to prevent. The use of laparoscopy has been shown to decrease the formation of peritoneal adhesions and adhesion related readmissions [1] Adjunctive measures such as hyaluronic acid-carboxymethylcellulose membrane (SeprafilmTM - Genzyme, Cambridge, MA), Icodextrin solution (AdeptTM - Baxter International, Deerfield, IL), knitted fabric of modified cellulose (InterceedTM - Johnson and Johnson, New Brunswick, NJ), or polyvinyl alcohol-based gels such as A-Part GelTM - Aesculap AG, Tuttlingen, Germany) have been shown to decrease adhesion burden to some extent. Their efficacy in the prevention of ASBO has yet to be identified [2]

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