Recurrence Following Operative vs. Non-Operative Management of Adhesive Small Bowel Obstruction in Children: A Multi-center Prospective Observational Study
Description
Utsav M Patwardhan, Romeo C Ignacio, Kaci Pickett-Nairne, Katie W Russell, Justin Lee, Ben Padilla, Caroline Melhado, Lorraine I Kelley-Quon, David H Rothstein, Hariharan Thangarajah, Ana Ibarra-Meraz, Rabab M Barq, Kezlyn E Larsen, Kathryn L Fowler, Zebediah Hunteman, Maria Valencia-Bradd, Katrine Lofberg, Aaron Jensen, Samir Pandya, Shannon N Acker; Western Pediatric Surgery Research Consortium
Objective: Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to non-operative management (NOM).
Methods: We conducted a prospective observational study of children with ASBO admitted to nine hospitals from 10/2020 to 12/2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.
Results: Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, twenty patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs. 6.1%, P=0.04). However, after adjusting for age (HR 0.35, CI 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.
Conclusion: Although the rate of recurrent ASBO in children is nearly 15% within one year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.
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