Non-operative management of small bowel obstruction in virgin abdomen: a systematic review

• Published in: Surgery today (Tokyo, Japan) Japan), 2021-10, Vol.51 (10), p.1558-1567
• Main Authors: Hew, Nicole, Ng, Zi Qin, Wijesuriya, Ruwan
• Format: Article
• Language: English
• Subjects: Conservative Treatment - methods; Conservative Treatment - statistics & numerical data; Digestive System Surgical Procedures - statistics & numerical data; Feasibility Studies; Female; Humans; Intestinal Obstruction - diagnostic imaging; Intestinal Obstruction - etiology; Intestinal Obstruction - therapy; Intestine, Small; Laparotomy; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Review Article; Safety; Surgery; Surgical Oncology; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-020-02210-4

The aim of this study was to systematically review the feasibility and safety of non-operative management of small bowel obstruction (SBO) in virgin abdomen. A systematic review was performed through December 2019. The primary outcome was the resolution of non-operative management of SBO in virgin abdomen. Secondary outcomes were the etiology of SBO and findings of exploratory laparotomy. Six studies were included in the analysis. Of the 442 patients, 2 with metastatic cancer received palliative care, and the management in 26 was not reported, so these patients were excluded. A total of 414 patients were ultimately analyzed, including 203 patients (49%) who were managed non-operatively and 211 (51%) who underwent surgical management. Of the 203 managed non-operatively, the condition of 194 (96%) was resolved without further intervention. The remaining 9 (5%) patients failed non-operative management and ultimately required surgery. Of the 211 patients who underwent surgical exploration, only 137 had their intraoperative findings reported. Adhesions ( n  = 67; 49%) were the main cause, followed by malignancy ( n  = 14; 10%) and others ( n  = 33; 24%). No cause was found in 23 patients (17%). In highly select cases of SBO with virgin abdomen, non-operative management can be attempted if patients are clinically stable and computed tomography does not demonstrate concerning features or obvious pathology. Further well-designed prospective studies will be required prior to the introduction of this concept in clinical practice, as current evidence remains heterogeneous.