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Войти в исследования Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2026
Early surgery for strangulated and non-strangulated small bowel obstruction has no advantages over delayed procedure, especially in elderly patients: results of a multicenter retrospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Tyagunov Alexander, Tyagunov Anton, Nechay Taras, Melnikov-Makarchuk Kirill, Alieva Zaripat, Abdulkarim Botan, Sazhin Alexander
Аннотация
BACKGROUND: Adhesive small bowel obstruction (SBO) can be managed surgically or non-operatively. However, there are still no well-established criteria for defining the optimal treatment strategy. Recent evidence suggests that early intervention within 24 hours of admission to hospital may benefit patients.
METHODS: This was a multicenter retrospective study of adhesive SBO investigating the outcomes of early surgery (<12 hours), delayed surgery, and nonoperative treatment in 143 patients. In addition, the impact of time to surgery was also assessed in cases of strangulated and non-strangulated SBO.
RESULTS: Sixty-six (46.2%) patients underwent surgery, which was initiated laparoscopically in 49 (74.2%) cases. Of them, 36 (54.5%) patients were operated on within 12 hours of admission, and another 30 (45.5%) after 12 hours. The remaining 77 (53.5%) patients were successfully treated nonoperatively. In-hospital mortality was 7%, and all deaths (n=10; mean age 75.4 years, standard deviation±13.1 years) occurred postoperatively. Time from admission to surgery was not associated with mortality from any type of obstruction (strangulated or non-strangulated). Mortality was higher among older patients (>75 years) with non-strangulated SBO (p=0.01).
CONCLUSIONS: The surgery performed in the first 12 hours of admission, whether for strangulated or non-strangulated adhesive SBO, did not show advantages over delayed surgery. A less aggressive approach to the treatment of older or frail patients would be a wiser option.
METHODS: This was a multicenter retrospective study of adhesive SBO investigating the outcomes of early surgery (<12 hours), delayed surgery, and nonoperative treatment in 143 patients. In addition, the impact of time to surgery was also assessed in cases of strangulated and non-strangulated SBO.
RESULTS: Sixty-six (46.2%) patients underwent surgery, which was initiated laparoscopically in 49 (74.2%) cases. Of them, 36 (54.5%) patients were operated on within 12 hours of admission, and another 30 (45.5%) after 12 hours. The remaining 77 (53.5%) patients were successfully treated nonoperatively. In-hospital mortality was 7%, and all deaths (n=10; mean age 75.4 years, standard deviation±13.1 years) occurred postoperatively. Time from admission to surgery was not associated with mortality from any type of obstruction (strangulated or non-strangulated). Mortality was higher among older patients (>75 years) with non-strangulated SBO (p=0.01).
CONCLUSIONS: The surgery performed in the first 12 hours of admission, whether for strangulated or non-strangulated adhesive SBO, did not show advantages over delayed surgery. A less aggressive approach to the treatment of older or frail patients would be a wiser option.