Recurrence Following Operative vs. Non-Operative Management of Adhesive Small Bowel Obstruction in Children: A Multi-center Prospective Observational Study
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Recurrence Following Operative vs. Non-Operative Management of Adhesive Small Bowel Obstruction in Children: A Multi-center Prospective Observational Study
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 12, 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.
Transcript
How do we best prevent recurrence of adhesive small bowel obstruction in children? I'm Lizzie Lee from Cincinnati Children's Hospital and this is an article you should know about. This study looked at whether surgery or nonoperative management was better to prevent recurrence of adhesive small bowel obstruction. Researchers conducted an observational study across nine hospitals following 136 children for a year after their initial adhesive small bowel obstruction treatment. They found that 14.7% of children experienced their recurrence with a higher unadjusted risk in the group that did not have surgery. However, after adjusting for age, there was no significant difference in recurrence rates between the two treatment groups. The key takeaway is that nonoperative management appears to be just as effective as surgery in preventing recurrence of small bowel obstruction. Let us know what you think in the comments below and stay tuned for more articles that you should know about.