Factors predicting the recurrence of adhesive small-bowel obstruction

Barkan, Howard; Webster, Steven; Ozeran, Steven

doi:10.1016/s0002-9610(99)80304-3

Cited by 115 publications

(80 citation statements)

References 17 publications

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“…35 A downfall of nonoperative management is that it is associated with an increased risk of recurrent SBO compared with surgery. 26,29,34,36 In the largest study of recurrent SBO (n = 32 583), Foster and colleagues 34 reported recurrence after 5 years of follow-up in 20% of patients treated nonoperatively compared with 16% of patients treated surgically. Readmission for recurrence happened earlier in the patients managed nonoperatively than in those managed surgically (median 194 v. 354 d).…”

Section: Discussionmentioning

confidence: 99%

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

et al. 2014

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Background:The purpose of this research was to examine the morbidity, mortality and rate of recurrent bowel obstruction associated with the treatment of small bowel obstruction (SBO) in older adults. Methods:We prospectively enrolled all patients 70 years or older with an SBO who were admitted to a tertiary care teaching centre between Jul. 1, 2011, and Sept. 30, 2012. Data regarding presentation, investigations, treatment and outcomes were collected. Results:Of the 104 patients admitted with an SBO, 49% were managed nonoperatively and 51% underwent surgery. Patients who underwent surgery experienced more complications (64% v. 27%, p = 0.002) and stayed in hospital longer (10 v. 3 d, p < 0.001) than patients managed nonoperatively. Nonoperative management was associated with a high rate of recurrent SBO: 31% after a median follow-up of 17 months. Of the patients managed operatively, 60% underwent immediate surgery and 40% underwent surgery after attempted nonoperative management. Patients in whom nonoperative management failed underwent surgery after a median of 2 days, and 89% underwent surgery within 5 days. The rate of bowel resection was high (29%) among those who underwent delayed surgery. Surgery after failed nonoperative management was associated with a mortality of 14% versus 3% for those who underwent immediate surgery; however, this difference was not significant. Conclusion:These data suggest that some elderly patients with SBO may be waiting too long for surgery.Contexte : Le but de cette recherche était d'analyser la morbidité, la mortalité et le taux de récurrence de l'occlusion intestinale associés au traitement de l'occlusion intestinale grêle (OIG) chez des adultes âgés.Méthodes : Nous avons inscrit de manière prospective tous les patients de 70 ans ou plus présentant une OIG qui ont été admis dans un établissement de soins tertiaires entre le 1er juillet 2011 et le 30 septembre 2012. Nous avons recueilli les données concernant les tableaux cliniques, les épreuves diagnostiques, les traitements et leurs résultats. Résultats :Parmi les 104 patients admis pour OIG, 49 % ont été traités non chirurgicalement et 51 % ont subi une intervention chirurgicale. Les patients soumis à la chirurgie ont présenté davantage de complications (64 % c. 27 %, p = 0,002) et ont séjourné plus longtemps à l'hôpital (10 j. c. 3 j., p < 0,001) comparativement aux patients qui n'ont pas été opérés. La prise en charge non chirurgicale a été associée à un taux élevé de récurrences de l'OIG : 31 % après un suivi médian de 17 mois. Parmi les patients opérés, 60 % ont subi une chirurgie immédiate et 40 % ont subi leur chirurgie après une tentative de prise en charge non chirurgicale. Les patients chez qui la prise en charge non chirurgicale a échoué ont subi leur chirurgie après une période médiane de 2 jours et 89 % en l'espace de 5 jours. Le taux de résection intestinale a été élevé (29 %) chez ceux dont la chirurgie a été retardée. La chirurgie après une intervention non chirurgicale infructueuse a été associée à un taux d...

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Section: Discussionmentioning

confidence: 99%

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

et al. 2014

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“…Neste ponto estuda-se a escolha entre abordagem laparoscópica ou laparotomia, com aparentes vantagens para a primeira via, à medida que a menor lesão peritoneal parece diminuir a presença de aderências 3,25,29 . O tratamento conservador mostra altos índi-ces de recidiva (53% após o primeiro episódio obstrutivo, 85% após o segundo) 30,31 . A decisão em favor da conduta clínica expectante justifica-se na tentativa de se evitar laparotomia, com sua morbidade associada.…”

Section: Obstrução Por Aderênciasunclassified

A videolaparoscopia no diagnóstico e tratamento da obstrução intestinal

Seid

Imperiale

Araújo

et al. 2007

Rev bras. colo-proctol.

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Resumo: A obstrução intestinal constitui complicação freqüente, de etiologia multifatorial, apresentação clínica variável e alta morbidade. Uma vez esgotados os recursos conservadores em casos específicos, a laparotomia exploradora é empregada para o diagnóstico final e tratamento em grande número de pacientes. Apesar do sucesso da via laparoscópica no manuseio de diversas afecções, a utilização desta via na abordagem inicial da obstrução do intestino delgado tem sido bastante limitada e alvo de numerosas críticas. Entretanto, o acúmulo de experiência com o método nos últimos anos, aliado ao avanço tecnológico e instrumental, têm permitido tratar número cada vez maior de pacientes obstruídos por meio do acesso laparoscópico. Assim, o surgimento de novos instrumentos como grampeadores laparoscópicos, pinças e trocáteres menos traumáticos ajudaram a tornar a videolaparoscopia factível e segura nestes pacientes. Neste artigo, os autores apresentam uma revisão sobre o papel da vídeo-cirurgia em casos selecionados de obstrução intestinal, ressaltando a contribuição dos métodos minimamente invasivos para o arsenal diagnóstico e terapêutico desta importante complicação. Descritores INTRODUÇÃOA obstrução intestinal é afecção freqüentemente encontrada em todo o mundo. Há grande diversidade entre os vários grupos de pacientes e civilizações, diferentes espectros de apresentação clínica, bem como etiologias diversas, que possibilitam uma larga faixa de diagnósticos e modalidades terapêuticas. Apesar dos avanços contínuos, todos os métodos diagnósticos apresentam limitações e, muitas vezes, o próprio procedimento terapêutico tem função diagnóstica 1 . A videolaparoscopia (VL) diagnóstica oferece vantagens de ser um procedimento pouco invasivo e de alta acurácia. Além disso o desconforto, os riscos, e os custos ao paciente são relativamente menores, podendo evitar investigações diagnósticas caras, e possibilitar tratamento definitivo no mesmo procedimento 2,3 .Tradicionalmente, a laparotomia exploradora é considerada a modalidade terapêutica de escolha para a grande maioria dos pacientes que necessitam de abordagem cirúrgica. Porém, os avanços na técnica videolaparoscópica e o aperfeiçoamento do instrumental têm encorajado a aplicação da VL nas doenças do intestino delgado.

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“…Recurrent intestinal obstruction is diagnosed in the same parameters mentioned before All· patients were followed up either through regular visits in the outpatient clinics at 6 months intervals. RESULTS In this study the male (21) to female (15) ratio for the patients with adhesive intestinal obstruction (1.4:1) Figure (1), and the age ranges in Group I from 19 to 60 years with mean of age was 34.2 years (±10.4) and in Group II from 20 to 60 years with mean of age was 33 years (±11.5). The highest age incidence was found to be in the third decade of life (15 patients) .as adhesive intestinal obstruction are more common in males than females, the patients aged below 18 years are excluded as they cannot give consent.…”

Section: Introductionmentioning

confidence: 70%

Evaluation of Post Operative Peritoneal Lavage to Prevent Recurrent Adhesive Intestinal Obstruction

Saady

Metwally

Hefny

et al. 2017

Zagazig University Medical Journal

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Objective: to evaluate the effectiveness of postoperative peritoneal lavage (PPL) in prevention of recurrent Adhesive Small Bowel Obstruction (ASBO).Patients and methods: a total of 36 patients were included in this study. All of these patients suffered from ASBO. They were randomized into two groups. Group I (18 patients) were treated with adhesiolysis followed by PPL and group II (18 patients) were treated with adhesiolysis alone . Patients w e r e followed up for an average period of 15 months to detect the incidence of recurrent ASBO. Results: :In group1 only one (5.6%) patient had an attack of ASBO which responded to conservative management and did not need redo operation while in group II s e v e n ( 3 8 . 9 % ) p a t i e n t s developed a recurrent episode of ASBO f o u r o f t h e m ( 2 2 . 2 % ) n e e d e d s u r g i c a l r e e x p l o r a t i o n . So the rate of surgical reoperation in group 1 was zero in comparison to group 2 which was( 16.6%). Conclusion: PPL is a new hope for prevention of recurrent ASBO that achieved statistically significant reduction in the recurrence rate and surgical redo.

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Factors predicting the recurrence of adhesive small-bowel obstruction

Cited by 115 publications

References 17 publications

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

A videolaparoscopia no diagnóstico e tratamento da obstrução intestinal

Evaluation of Post Operative Peritoneal Lavage to Prevent Recurrent Adhesive Intestinal Obstruction

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