Early Postoperative Small Bowel Obstruction is an Independent Risk Factor for Subsequent Adhesive Small Bowel Obstruction in Patients Undergoing Colectomy

Abstract

Introduction: This study was carried out to investigate whether postoperative ileus (POI) or early postoperative small bowel obstruction (EPSBO) affects the development of adhesive small bowel obstruction (SBO) in patients who underwent colectomy.

Methods: A total of 1002 patients who consecutively underwent open colectomy by a single surgeon were prospectively enrolled. POI was defined as the absence of bowel function for more than 5 days or as the delay of the oral intake beyond postoperative 7 days. EPSBO was defined as clinical and radiologic findings of SBO between postoperative 7 to 30 days after resuming oral intake. Median follow up period was 51 months.

Results: Eighty five patients (8.5%) developed POI and 42 patients (4.2%) developed EPSBO, with seven of them experiencing both POI and EPSBO. During the follow-up period, seventy patients (7.0%) developed adhesive SBO, eleven (15.7%) of whom needed laparotomy. Likelihood of adhesive SBO in patients with EPSBO was 21.4% and without EPSBO was 6.4% (p=0.0001). But that in patients with POI was 10.6% and without POI was 6.7% (p>0.05). The cumulative risk of adhesive SBO was 8.3% at 5 years while that in patients with and without EPSBO was 26.5% and 7.5% each (p<0.001). Multivariate analysis showed IPAA (HR=3.988, p=0.028), colostomy (HR=2.254, p=0.024) and EPSBO (HR=4.077, p=0.001) as independent risk factors for adhesive SBO.

Conclusions: Development of adhesive SBO after coletomy is more frequent in patients with EPSBO as well as IPAA and colostomy but POI does not increase the risk of adhesive SBO.