Early postoperative small bowel obstruction is an independent risk factor for subsequent adhesive small bowel obstruction in patients undergoing colectomy

Abstract

Aim: We investigated the association between postoperative ileus (POI) and early postoperative small bowel obstruction (EPSBO) with the development of adhesion-related small bowel obstruction (SBO) after colectomy. Method(s): One thousand two patients who underwent open colectomy by a single surgeon were prospectively enrolled. POI was defined as the absence of bowel function for five or more days or the delay to oral feeding within 7 days. EPSBO was defined as clinical and radiologic symptoms and signs of SBO between postoperative days 7-30 after resuming oral intake. Result(s): Median follow up was 44.1 (1-82) months. Eight-five percent (8.5%) patients developed POI, and 42 (4.2%) developed EPSBO. During follow-up, 70 (7.0%) patients developed adhesionrelated SBO, 11 (15.7%) of whom needed laparotomy. The cumulative incidence of adhesive SBO was 3.9% at 1 year, 6.1% at 3 years and 6.8% at 5 years. Univariate analysis demonstrated significant correlations between occurrence of adhesive SBO and the presence of a stoma and EPSBO (P = 0.008 and P = 0.002, respectively). Multivariate analysis showed the presence of a stoma (odds ratio 2.393, P = 0.019) and EPSBO (odds ratio 3.99, P < 0.001) to be independent risk factors for adhesion-related SBO while POI was not related to its development. Conclusion(s): The presence of a stoma and an early episode of small bowel obstruction postoperatively are risk factors for subsequent intestinal obstruction.