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. 2023 Aug 1;109(8):2185-2195.
doi: 10.1097/JS9.0000000000000471.

Variation in the management of adhesive small bowel obstruction in the Netherlands: a prospective cross-sectional study

Pepijn Krielen  1   2 , Lisa P A Kranenburg  3 , Martijn W J Stommel  1 , Nicole D Bouvy  3 , Pieter J Tanis  4   5 , Jorn J Willemsen  1 , Jorne Migchelbrink  1 , Rick de Ree  1 , Esther M G Bormans  1 , Harry van Goor  1 , Richard P G Ten Broek  1 ; ASBO Snapshot Study Group
Collaborators, Affiliations

Variation in the management of adhesive small bowel obstruction in the Netherlands: a prospective cross-sectional study

Pepijn Krielen et al. Int J Surg. .

Abstract

Background: ASBO is a frequent abdominal surgical emergency and a leading cause of morbidity and mortality in emergency surgery. The aim of this study is to provide insight into the current management of adhesive small bowel obstruction (ASBO) and associated outcomes.

Methods and materials: A nationwide prospective cross-sectional cohort study was conducted. All patients with clinical signs of ASBO admitted to participating Dutch hospitals were included during a 6 months inclusion period between April 2019 and December 2020. Ninety-day clinical outcomes were described and compared for nonoperative management (NOM) and laparoscopic and open surgery.

Results: In 34 participating hospitals, 510 patients were included, of whom 382 (74.9%) had a definitive diagnosis of ASBO. Initial management consisted of emergency surgery in 71 (18.6%) patients and NOM in 311 (81.4%) patients, 119 (31.1%) of whom required delayed surgery after failure of NOM. Surgical interventions started laparoscopically in 51.1%, of which 36.1% were converted to laparotomy. Intentional laparoscopy resulted in shorter hospital stays compared with open surgery (median 8.0 vs. 11.0 days; P <0.001) and comparable hospital mortality (5.2 vs. 4.3%; P =1.000). Oral water-soluble contrast use was associated with a decreased length of stay ( P =0.0001). Hospital stay for surgical patients was shorter in patients who were operated on within 72 h of admission ( P <0.001).

Conclusion: This nationwide cross-sectional study demonstrates shorter hospital stay in ASBO patients who received water-soluble contrast, were operated within 72 h of admission or were operated with minimally invasive techniques. Results may support the standardization of ASBO treatment.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of inclusion of patients with the suspicion of adhesive small bowel obstruction (ASBO), initial and definitive treatment groups of patients with ASBO and operatively treated subgroups. NOM, nonoperative management.
See this image and copyright information in PMC

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