COMPREHENSIVE DIAGNOSTIC AND TREATMENT ALGORITHM FOR THE SURGICAL MANAGEMENT OF POSTOPERATIVE ADHESIVE SMALL BOWEL OBSTRUCTION: RESULTS OF A COMPARATIVE CLINICAL STUDY
DOI:
https://doi.org/10.32345/USMYJ.3(164).2026.184-196Keywords:
adhesive small bowel obstruction; laparoscopic adhesiolysis; hydrojet scalpel; complications; quality of lifeAbstract
Introduction. Postoperative adhesive small bowel obstruction (ASBO) remains one of the most common indications for emergency surgery in abdominal surgery and accounts for up to 60–75% of all cases of mechanical intestinal obstruction.
Aim. To evaluate the effectiveness of a comprehensive diagnostic and treatment algorithm incorporating laparoscopic adhesiolysis, the hydrojet scalpel and the author’s own surgical techniques compared with standard treatment in patients with postoperative adhesive small bowel obstruction, based on the incidence of postoperative complications, mortality and quality-of-life outcomes.
Materials and methods. A comparative cohort study of the treatment outcomes of 314 patients with postoperative adhesive small bowel obstruction was conducted: 163 patients in the control group, treated in 2006-2012 using the conventional approach, and 151 patients in the study group, treated in 2013-2019 after implementation of the improved algorithm. In the study group, a laparoscopic approach was used in 84 patients and the hydrojet scalpel in 82 (54.30%). The rates of bowel resection, stoma formation, postoperative complications, reoperations and in-hospital mortality, as well as quality-of-life outcomes, were assessed. The SF-36 was administered to 180 patients at discharge and at 1 and 3 months. The groups were comparable in terms of age, sex, stage of the disease, time to admission and grade of intra-abdominal hypertension. Owing to the retrospective nature of the control cohort, multivariable analysis was not performed; unadjusted ORs with 95% CIs are reported.
Results. The bowel resection rate was lower in the study group than in the control group: 14.57% vs. 25.15% (OR=0.51; 95% CI 0.29-0.90; p=0.02). The rate of wound complications was 6.62% vs. 20.24% (OR=0.28; 95% CI 0.13-0.59; p<0.001), and the rate of intra-abdominal complications requiring reoperation was 7.28% vs. 22.08% (OR=0.28; 95% CI 0.14-0.57; p<0.001). The rate of intestinal stoma formation was lower in the study group, but the difference was not statistically significant: 8.61% vs. 14.72% (p=0.09). In-hospital mortality was 1.32% vs. 3.07% (p=0.28). Use of the comprehensive diagnostic and treatment algorithm was associated with lower rates of bowel resection and postoperative complications, wider use of the laparoscopic approach and better quality-of-life outcomes.
Conclusions. Use of the comprehensive diagnostic and treatment algorithm was associated with lower rates of bowel resection and postoperative complications, wider use of the laparoscopic approach and better quality-of-life outcomes. Differences in the rates of intestinal stoma formation and in-hospital mortality did not reach statistical significance.
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