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

Amit Sastry, Maria Grigoreva, I. Michael Leitman^*

Department of Surgery, Mount Sinai Beth Israel - Icahn School of Medicine at Mount Sinai, New York, USA.

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 < 0.05) and for every prior surgery, the odds increased by 24% (p < 0.05). The presence of ASA Classification > 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.

Keywords

Adhesions, Obstruction, Intestinal, Laparotomy, Small Bowel, Post-Operative, Complication

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Okabayashi, K., et al. (2014) Adhesions after Abdominal Surgery: A Systematic Review of the Incidence, Distribution and Severity. Surgery Today, 44, 1685-1691. http://dx.doi.org/10.1007/s00595-013-0748-5
[2]	Diamond, M.P., et al. (2010) Review Article: Adhesion Prevention and Reduction: Current Status and Future Recommendations of a Multinational Interdisciplinary Consensus Conference. Surgical Innovation, 17, 183-188. http://dx.doi.org/10.1177/1553350610379869
[3]	Arung, W., Meurisse, M. and Detry, O. (2011) Pathophysiology and Prevention of Postoperative Peritoneal Adhesions. World Journal of Gastroenterology, 17, 4545-4553. http://dx.doi.org/10.3748/wjg.v17.i41.4545
[4]	Attard, J.A.P. and MacLean, A.R. (2007) Adhesive Small Bowel Obstruction: Epidemiology, Biology and Prevention. Canadian Journal of Surgery, 50, 291-300.
[5]	Liakakos, T., Thomakos, N., Fine, P.M., Dervenis, C. and Young, R.L. (2001) Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Signifi-cance. Recent Advances in Prevention and Management. Digestive Surgery, 18, 260- 273. http://dx.doi.org/10.1159/000050149
[6]	ten Broek, R.P.G., Issa, Y., van Santbrink, E.J.P., Bouvy, N.D., Kruitwagen, R.F.P.M., Jeekel, J., Bakkum, E.A., Rovers, M.M. and van Goor, H. (2013) Burden of Adhesions in Abdominal and Pelvic Surgery: Systematic Review and Metanalysis. BMJ, 347, f5588. http://dx.doi.org/10.1136/bmj.f5588
[7]	Branco, B.C., Barmparas, G., Schnüriger, B., Inaba, K., Chan, L.S. and Demetriades, D. (2010) Systematic Review and Meta-Analysis of the Diagnostic and Therapeutic Role of Water-Soluble Contrast Agent in Adhesive Small Bowel Obstruction. British Journal of Surgery, 97, 470-478. http://dx.doi.org/10.1002/bjs.7019
[8]	Kossi1, J., Salminen, P. and Laato, M. (2004) The Epidemiology and Treatment of Patterns of Postoperative Adhesion Induced Intestinal Obstruction in Varsinais-Suomi Hospital District. Scandinavian Journal of Surgery, 93, 68-72.
[9]	Ouaissi, M., et al. (2012) Post-Operative Adhesions after Digestive Surgery: Their Incidence and Prevention: Review of the Literature. Journal of Visceral Surgery, 149, e104-e114.
[10]	Catena, F., Di, S.S., Kelly, M.D., Biffl, W.L., Ansaloni, L., Mandala, V., Velmahos, G.C., Sartelli, M., Tugnoli, G., Lupo, M., Mandala, S., Pinna, A.D., Sugarbaker, P.H., Van Goor, H., Moore, E.E. and Jeekel, J. (2011) Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery, 6, 5.
[11]	Carmichael, J.C. and Mills, S. (2006) Reoperation for Small Bowel Obstruction—How Critical Is the Timing? Clinics in Colon and Rectal Surgery, 19, 181-187. http://dx.doi.org/10.1055/s-2006-956438
[12]	Parker, M.C., Wilson, M.S., Menzies, D., Sunderland, G., Thompson, J.N., Clark, D.N., et al. (2004) Colorectal Surgery: The Risk and Burden of Adhesion-Related Complications. Colorectal Disease, 6, 506-511. http://dx.doi.org/10.1111/j.1463-1318.2004.00709.x
[13]	Beck, D.E. (2006) Reoperative Surgery: What Can We Learn from a Large Randomized Prospective Trial? Clinics in Colon and Rectal Surgery, 19, 247-250. http://dx.doi.org/10.1055/s-2006-956447
[14]	Parker, M.C., Wilson, M.S., Menzies, D., Sunderland, G., Clark, D.N., Knight, A.D., et al. (2005) The SCAR-3 Study: 5-Year Adhesion-Related Readmission Risk Following Lower Abdominal Surgical Procedures. Colorectal Disease, 7, 551-558. http://dx.doi.org/10.1111/j.1463-1318.2005.00857.x
[15]	Ten Broek, R.P.G., Issa, Y., van Santbrink, E.J.P., Bouvy, N.D., Kruitwagen, R.F.P.M., Jeekel, J., Bakkum, E.A., Rovers, M.M. and van Goor, H. (2013) Burden of Adhesions in Abdominal and Pelvic Surgery: Systematic Review and Met-Analysis. British Medical Journal, 347, f5588. http://dx.doi.org/10.1136/bmj.f5588
[16]	Barmparas, G., Branco, B.C., Schnüriger, B., Lam, L., Inaba, K. and Demetriades, D. (2010) The Incidence and Risk Factors of Post-Laparotomy Adhesive Small Bowel Obstruction. Journal of Gastrointestinal Surgery, 14, 1619-1628. http://dx.doi.org/10.1007/s11605-010-1189-8
[17]	Andersson, R.E.B. (2001) Small Bowel Obstruction after Appendicectomy. British Journal of Surgery, 88, 1387-1391. http://dx.doi.org/10.1046/j.0007-1323.2001.01869.x
[18]	Duron, J.J., Silva, N.J., du Montcel, S.T., Berger, A., Muscari, F., Hennet, H., Veyrieres, M. and Hay, J.M. (2006) Adhesive Postoperative Small Bowel Obstruction: Incidence and Risk Factors of Recurrence after Surgical Treatment: A Multicenter Prospective Study. Annals of Surgery, 244, 750-757.
[19]	Zielinski, M.D. and Bannon, M.P. (2011) Current Management of Small Bowel Obstruction. Advances in Surgery, 45, 1-29, Review.
[20]	Cooke, S.A. and Hamilton, D.G. (1977) The Significance of Starch Powder Contamination in the Aetiology of Peritoneal Adhesions. British Journal of Surgery, 64, 410-412. http://dx.doi.org/10.1002/bjs.1800640610
[21]	Scholin, J., Buunen, M., Hop, W., Bonjer, J., Anderberg, B., Cuesta, M., Delgado, S., Ibarzabal, A., Ivarsson, M.L., Janson, M., Lacy, A., Lange, J., Pahlman, L., Skullman, S. and Haglind, E. (2011) Bowel Obstruction after Laparoscopic and Open Colon Resection for Cancer: Results of 5 Years of Follow-Up in a Randomized Trial. Surgical Endoscopy, 25, 3755-3760. http://dx.doi.org/10.1007/s00464-011-1782-2
[22]	Schnüriger, B., Barmparas, G., Branco, B.C., Lustenberger, T., Inaba, K. and Demetriades, D. (2011) Prevention of Postoperative Peritoneal Adhesions: A Review of the Literature. The American Journal of Surgery, 201, 111-121. http://dx.doi.org/10.1016/j.amjsurg.2010.02.008
[23]	van der Wal, J.B., Iordens, G.I., Vrijland, W.W., van Veen, R.N., Lange, J. and Jeekel, J. (2011) Adhesion Prevention during Laparotomy: Long-Term Follow-Up of a Randomized Clinical Trial. Annals of Surgery, 253, 1118-1121. http://dx.doi.org/10.1097/SLA.0b013e318217e99c
[24]	Reshef, A., Hull, T.L. and Kiran, R.P. (2013) Risk of Adhesive Obstruction after Colorectal Surgery: The Benefits of the Minimally Invasive Approach May Extend Well beyond the Perioperative Period. Surgical Endoscopy, 27, 1717-20. http://dx.doi.org/10.1007/s00464-012-2663-z
[25]	Dolejs, S., Kennedy, G. and Heise, C.P. (2011) Small Bowel Obstruction Following Restorative Proctocolectomy: Affected by a Laparoscopic Approach? Journal of Surgical Research, 170, 202-208. http://dx.doi.org/10.1016/j.jss.2011.03.004