Small bowel obstruction: Conservative vs. surgical management

PURPOSE: The aim of this study was to assess incidence, risk factors, and recurrence rates for conservative and surgical management of small bowel obstruction. METHODS: Retrospective chart review was conducted of 329 patients accounting for 487 admissions with small bowel obstruction. Data were obtained from the institutional database and patient charts. Patients with early recurrent small bowel obstruction had prior operations or hospitalization with conservative therapy for small bowel obstruction, then had a hospital stay >10 days following abdominal surgery because of obstruction or required readmission for small bowel obstruction within 30 days. Patients treated for prior small bowel obstruction and then readmitted after 30 days for a recurrent small bowel obstruction were classified as having late recurrent small bowel obstruction. RESULTS: A total of 329 patients with a diagnosis of small bowel obstruction were identified. At index admission, 43 percent (142) were successfully treated conservatively, whereas 57 percent (187) failed conservative treatment and underwent surgery. Overall, there were eight early deaths, four in each group (2.8 percent conservative vs. 2.1 percent surgical; no significant difference). The frequency of recurrence for those treated nonoperatively was 40.5 percent compared with 26.8 percent for patients treated operatively (P < 0.009). Patients treated without operation had a significantly shorter time to recurrence (mean, 153 vs. 411 days; P < 0.004) and had fewer hospital days for their index small bowel obstruction (4.9 vs. 12.0 days; P < 0.0001). Two hundred one (63 percent) patients had abdominal surgery and 119 (37 percent) patients had no prior abdominal surgery before developing a small bowel obstruction. Previous abdominal operations by procedure type were colorectal surgery (34 percent), gynecologic surgery (28 percent), exploratory laparotomy (20 percent), appendectomy (14 percent), cholecystectomy (12 percent), herniorraphy (8 percent), and gastric bypass (5 percent). The mean time interval between initial procedure and index small bowel obstruction was 1.3 years for gastric bypass, 6.1 years for herniorraphy, 7.8 years for exploratory laparotomy, 8 years for cholecystectomy, 8.4 years for colorectal surgery, 11.8 years for gynecologic surgery, and 22.5 years for appendectomy. There was no significant difference between early and late recurrent small bowel obstruction in patients treated nonoperatively or operatively, regardless of prior history of abdominal surgery. Logistic regression analysis failed to identify any specific risk factors that were predictors of the success of conservative or surgical management. CONCLUSIONS: Operatively treated patients had a lower frequency of recurrence and a longer time interval to recurrence; however, they also had a longer hospital stay than that of patients treated nonoperatively. There was no significant difference in treatment type or in incidence or type of prior surgery among patients with early and late small bowel obstruction. None of the variables analyzed in this study were significant predictors of the success of a particular treatment.