CONSERVATIVE MANAGEMENT OF SMALL BOWEL OBSTRUCTION DUE TO POSTOPERATIVE ADHESIONS

Abstract

Conservative (nonoperative) management has been widely used in patients who have small bowel obstructions without strangulation due to postoperative adhesions. In this study, the efficacy of the nonoperative method in the therapy and whether it increases the morbidity and mortality of a possible subsequent surgical therapy, is assessed. Here we present 137 patients with small bowel obstructions due to postoperative adhesions. In the 30 patients strangulation was suspected according to their physical finding and immediate laparatomy was performed. 13 of these 30patients had strangulation. Conservative therapy was instituted in 107 patients, In 82 of them (76.6%) this therapy succeeded. The success rate was 85.5% in incomplete obstructions and 50.0% incomplete obstructions. The 25 patients in which the conservative therapy was unsuccessful underwent exploratrice laparatomy. In 3 (12 %) of them strangulation was seen. In our series there was no mortality. There was no complication due to conservative treatment, whereas morbidity was 16%for delayed surgical intervention. The results revealed that, small bowel obstruction due to postoperative adhesions can be treated successfully in 76.6% by conservative therapy. Also, delayed surgical intervention did not bring additional risks for the patients compared to immediate surgical treatment.