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Surgical management reduces recurrence of adhesive small bowel obstruction without significant increase in complications.
Adhesive small bowel obstruction (ASBO) remains one of the most frequent causes of hospitalization for intestinal obstruction, most often occurring as a long-term consequence of prior abdominal surgery and intra-abdominal adhesions. Although conservative (non-operative) care is commonly advocated as first-line therapy in clinically stable patients, recurrence rates remain high and real-world treatment practices vary widely. A new systematic review and meta-analysis provides robust comparative evidence on recurrence and complication outcomes following surgical versus conservative management of ASBO.
Comparative studies evaluating surgical and conservative management strategies for ASBO were eligible for inclusion. Outcomes of interest included ASBO recurrence and overall complication rates. Risk of bias was examined via validated tools: the Newcastle–ottawa scale for the observational studies and the Cochrane risk of bias tool for the randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals were examined via random-effects models to account for between-study variability. Using the I² statistic, statistical heterogeneity was quantified.
A total of 10 comparative studies encompassing 46,212 patients with ASBO were included in the final analysis. Surgical management was linked with a markedly lower risk of recurrence when compared with conservative treatment (OR: 0.52, I² = 85%). The surgical group exhibited a higher incidence of overall complications; however, this difference did not reach statistical significance (OR: 2.23, I² = 65%). Despite notable heterogeneity, the direction of effect consistently favored surgery for recurrence prevention across studies.
Thus, surgical intervention substantially minimizes the likelihood of recurrent ASBO, nearly halving the odds of recurrence when compared with conservative management. Importantly, this benefit does not appear to be accompanied by a statistically significant rise in short-term complication risk.
The American Journal of Gastroenterology
S3047 Surgical vs Conservative Management of Patients With Adhesive Small Bowel Obstruction: An Updated Systematic Review and Meta-Analysis
Maheshwari PK et al.
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