Long-term Prognosis After Operation for Adhesive Small Bowel
Long-term Prognosis After Operation for Adhesive Small Bowel
Aim of Study: The objective of this study was to determine the pattern of recurrence after one or more episodes of adhesive small bowel obstruction (ASBO) during a follow-up period of up to 40 years. Furthermore, we wanted to analyze possible factors with an influence on the recurrence rate and to study the magnitude of everyday abdominal pain among these patients.
Patients and Methods: Hospital records of 500 patients operated on for adhesive obstruction at Haukeland University Hospital from 1961 to 1995 were studied. The patients were followed until death, loss to follow-up, or end of study (February 2002), with a median follow-up of 10 years and a maximum follow-up time of 40 years. A questionnaire was sent to all living patients to obtain information on recurrences and abdominal complaints.
Results: The cumulative recurrence rate for patients operated once for ASBO was 18% after 10 years and 29% at 30 years. For patients admitted several times for ASBO, the relative risk of recurrent ASBO increased with increasing number of prior ASBO episodes. The cumulative recurrence rate reached 81% for patients with 4 or more ASBO admissions. Other factors influencing the recurrence rate were the method of treatment of the last previous ASBO episode (conservative versus surgical) and the number of abdominal operations prior to the initial ASBO operation. Compared to results from the general populations, more ASBO patients suffer from abdominal pain at home. Women and patients having matted adhesions have significantly more complaints about abdominal pain than men and patients with band adhesions.
Conclusion: The risk of recurrence increased with increasing number of ASBO episodes. Most recurrent ASBO episodes occur within 5 years after the previous one, but a considerable risk is still present 10 to 20 years after an ASBO episode. Surgical treatment decreased the risk of future admissions for ASBO, but the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment. People treated for ASBO seem to be more prone to experiencing abdominal pain than the normal population, especially those having matted adhesions.
The recurrent nature of adhesive small bowel obstruction (ASBO) represents a major clinical problem. Because adhesive obstruction commonly follows previous abdominal surgery, surgical treatment may seem like a paradox. However, in many patients, the obstruction will not resolve without surgery, and in others, the risk of strangulation offers the surgeon no other alternative.
The recurrence rate after an ASBO admission given in previous studies varies from 19% to 53%. Recurrence rates varies according to whether the patients were operated on or not, how the recurrence rates were calculated (ie, whether or not the length of follow-up for each patient was considered), the selection of patients for each study, and the treatment policy of the institution (early operation versus watchful waiting).
In a study by Miller et al, the number of previous ASBO episodes was a significant factor influencing the risk of having a recurrent ASBO admission. Others have found that the method of treatment (surgical or conservative) significantly influenced the risk of recurrence, with patients treated conservatively having the highest recurrence rate.
The focus of this study was to investigate the pattern of recurrence in patients operated for ASBO. By presenting the course of disease for 500 patients followed for up to 40 years, the risk of recurrence after 1 or several ASBO episodes was studied as well as the time to recurrence. Potential factors having an impact on the risk of recurrence were studied, as were abdominal discomfort and pain among these patients.
Aim of Study: The objective of this study was to determine the pattern of recurrence after one or more episodes of adhesive small bowel obstruction (ASBO) during a follow-up period of up to 40 years. Furthermore, we wanted to analyze possible factors with an influence on the recurrence rate and to study the magnitude of everyday abdominal pain among these patients.
Patients and Methods: Hospital records of 500 patients operated on for adhesive obstruction at Haukeland University Hospital from 1961 to 1995 were studied. The patients were followed until death, loss to follow-up, or end of study (February 2002), with a median follow-up of 10 years and a maximum follow-up time of 40 years. A questionnaire was sent to all living patients to obtain information on recurrences and abdominal complaints.
Results: The cumulative recurrence rate for patients operated once for ASBO was 18% after 10 years and 29% at 30 years. For patients admitted several times for ASBO, the relative risk of recurrent ASBO increased with increasing number of prior ASBO episodes. The cumulative recurrence rate reached 81% for patients with 4 or more ASBO admissions. Other factors influencing the recurrence rate were the method of treatment of the last previous ASBO episode (conservative versus surgical) and the number of abdominal operations prior to the initial ASBO operation. Compared to results from the general populations, more ASBO patients suffer from abdominal pain at home. Women and patients having matted adhesions have significantly more complaints about abdominal pain than men and patients with band adhesions.
Conclusion: The risk of recurrence increased with increasing number of ASBO episodes. Most recurrent ASBO episodes occur within 5 years after the previous one, but a considerable risk is still present 10 to 20 years after an ASBO episode. Surgical treatment decreased the risk of future admissions for ASBO, but the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment. People treated for ASBO seem to be more prone to experiencing abdominal pain than the normal population, especially those having matted adhesions.
The recurrent nature of adhesive small bowel obstruction (ASBO) represents a major clinical problem. Because adhesive obstruction commonly follows previous abdominal surgery, surgical treatment may seem like a paradox. However, in many patients, the obstruction will not resolve without surgery, and in others, the risk of strangulation offers the surgeon no other alternative.
The recurrence rate after an ASBO admission given in previous studies varies from 19% to 53%. Recurrence rates varies according to whether the patients were operated on or not, how the recurrence rates were calculated (ie, whether or not the length of follow-up for each patient was considered), the selection of patients for each study, and the treatment policy of the institution (early operation versus watchful waiting).
In a study by Miller et al, the number of previous ASBO episodes was a significant factor influencing the risk of having a recurrent ASBO admission. Others have found that the method of treatment (surgical or conservative) significantly influenced the risk of recurrence, with patients treated conservatively having the highest recurrence rate.
The focus of this study was to investigate the pattern of recurrence in patients operated for ASBO. By presenting the course of disease for 500 patients followed for up to 40 years, the risk of recurrence after 1 or several ASBO episodes was studied as well as the time to recurrence. Potential factors having an impact on the risk of recurrence were studied, as were abdominal discomfort and pain among these patients.
