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 21 November 2017

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News

Long-term prognosis after operation for small bowel obstruction

Most recurrent adhesive small bowel obstruction episodes occur within 5 years after the previous one, find doctors in the August issue of the Annals of Surgery.

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In this study, doctors determined the pattern of recurrence after 1 or more episodes of adhesive small bowel obstruction during a follow-up period of up to 40 years.

The team assessed the factors influencing the recurrence rate, as well as the magnitude of "everyday" abdominal pain in these patients.

The team evaluated the hospital records of 500 patients operated on for adhesive obstruction at Haukeland University Hospital, between 1961 to 1995.

The patients were followed until death, loss to follow-up, or end of study.
Patients with matted adhesions had more abdominal pain.
Annals of Surgery

The doctors sent questionnaires to all living patients to obtain data on recurrence and abdominal complaints.

The team found that the cumulative recurrence rate for patients operated once for adhesive small bowel obstruction was 18% after 10 years and 29% at 30 years.

They also determined that for patients admitted several times for adhesive small bowel obstruction, the relative risk of recurrence increased with increasing number of prior episodes.

The team calculated that the cumulative recurrence rate was 81% for patients with 4 or more adhesive small bowel obstruction admissions.

The team identified several other factors influencing recurrence rate. These included the method of treatment of the last obstruction episode, and the number of abdominal operations prior to the initial adhesive small bowel obstruction operation.

When compared to the general population, the team found that more adhesive small bowel obstruction patients suffer from abdominal pain at home.

Patients with matted adhesions had significantly more abdominal pain than patients with band adhesions.

Dr Bjorg-Tilde Svanes Fevang and colleagues concluded, "The risk of recurrence increased with increasing number of adhesive small bowel obstruction episodes".

"Most recurrent adhesive small bowel obstruction episodes occur within 5 years after the previous one, but a considerable risk is still present 10 to 20 years after an adhesive small bowel obstruction episode".

"Surgical treatment decreased the risk of future admissions for adhesive small bowel obstruction, but the risk of new surgically treated adhesive small bowel obstruction episodes was the same regardless of the method of treatment".

"People treated for adhesive small bowel obstruction seem to be more prone to experiencing abdominal pain than the normal population, especially those having matted adhesions".

Ann Surg 2004; 240(2): 193-201
04 August 2004

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