Small bowel obstruction caused by single adhesive band: Laparoscopic operative treatment should take priority over non-operative treatment

Yoo Shin Choi, MD, Suk Won Suh, MD. Chung-Ang University

Background  Small bowel obstruction (SBO) is a frequent cause of emergency surgical admission. Most surgeons advocate a trial of non-operative treatment (NT), but others favor operative treatment (OT) because of the high recurrence, morbidity and mortality rate associated with delaying surgery. We compared the postoperative outcomes of the two groups (OT and NT) to evaluate a better result for SBO, especially, caused by single adhesive band.

Methods  Among the total 62 patients, 16 were in the OT group (operated by laparoscopy) and 46 in the NT group. Early (duration of hospital stay, time to flatus, oral intake and defecation after start of treatment, as well as morbidity and mortality) and late postoperative outcomes (the recurrence rate, the time interval between discharge and recurrence of SBO) were evaluated.

Results  The times to first flatus, oral intake and defecation after treatment were significantly shorter in the OT group (p = 0.030, 0.033 and 0.024). The recurrence rate was significantly lower in the OT group than in the NT group (6.2 vs. 32.6 percent, p = 0.038). The time from discharge to first recurrence was significantly longer in the OT group than in the NT group (172 vs. 104.6 ± 26.5 days, p = 0.027).

Conclusions  SBO with single adhesive band is not effectively treated by NT, however, OT has notable success if the surgery is performed early. Therefore, patients presenting with SBO especially, caused by single adhesive band can be initially managed with laparoscopic OT.