Adhesive small bowel obstruction: temporary evolution and derived practical consequences.
OBJECTIVE
a study is made of the course of adhesive small bowel obstruction in an attempt to draw conclusions regarding useful measures for reducing its incidence and severity.


METHODS
a retrospective study is made of 146 cases of adhesive small bowel obstruction from the last adhesion-related hospital admission of each patient, with an evaluation of Kaplan-Meier survival curve fit to the principal parametric distributions of the disorder.


RESULTS
surgery of the appendix was the type of prior surgery most frequently associated with adhesion occlusion. The mean latency was close to 8 years, with a constant incidence rate of 0.128 cases/patient and year. The initial latency was shorter for colorectal surgery and for prior inframesocolic surgery in general, as well as for conditions of relapse. A prospective follow-up comprising most of the cases (i.e., 95%) could require over 20 years, or up to 10 years to assess the corresponding relapses.


CONCLUSIONS
from the clinical research perspective, the best approach to the problem of adhesive small bowel obstruction comprises the evaluation of prophylactic measures against adhesion formation. The more reliable methodological design of investigational studies must be sustained by prospective follow-up supported by hospital admission databases.
Escrig Sos
V J
VJ
Servicio de Cirugía General. Hospital General de Castellón. Spain. jescrig@comcas.es
Angel Yepes
V
V
Senent Vizcaíno
V
V
D018450:Disease Progression; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery / Q000628:therapy