Clinical Outcomes of Non-Operative Versus Operative Treatment in Adhesive Small Bowel Obstruction: A Systematic Review and Meta-Analysis.

BACKGROUND

Adhesive small bowel obstruction (ASBO) accounts for 65%-75% of all reported small bowel obstructions, primarily occurring following abdominal surgery. Although conservative treatment is effective in most cases, adhesions remain, which frequently recur. This systematic review and meta-analysis aimed to compare operative and non-operative management of ASBO with respect to recurrence rate and other clinical outcomes.

METHODS

PubMed, Embase and Cochrane Library databases were searched for randomised and non-randomised studies (NRSs) comparing operative with non-operative management of ASBO in November 2025. The pooled results for recurrence, mortality, complications and length of hospital stay (LOS) were analysed. The Risk Of Bias In Non-randomized Studies-of Interventions was used to assess the risk of bias.

RESULTS

One randomised controlled study and 26 NRSs were selected, with a total of 91 838 patients enrolled. Recurrence rate was significantly reduced with operative management across all study designs, including NRSs using clinical and administrative data analyses. No significant differences in mortality rates were observed between the two groups across all time periods and study designs, except for short-term mortality in NRSs using clinical data. Operative treatment was associated with significantly higher complication rates than non-operative treatment. LOS was generally longer and treatment costs were higher in the operative group than in the non-operative group.

CONCLUSION

Operative management reduces the recurrence of ASBO compared with non-operative treatment; however, it is associated with higher complication rates, longer LOS and increased costs. Elective surgery may benefit patients with recurrent episodes.