Bowel obstruction in bariatric and nonbariatric patients: major differences in management strategies and outcome.
BACKGROUND
Postoperative bowel obstruction is a common condition with standard management algorithms. Bowel obstruction after bariatric surgery could require markedly different management strategies and have different outcomes.


METHODS
All patients admitted for bowel obstruction were identified from the 2006 and 2007 Nationwide Inpatient Sample. Postbariatric (BAR) patients were identified and compared with the nonbariatric (NB) population for differences in demographics, operative interventions, and morbidity/mortality.


RESULTS
A total of 9505 admissions for bowel obstruction in BAR patients and 54,342 in NB patients were found. The source of obstruction was most commonly the abdominal wall/internal hernias in the BAR group and adhesions in the NB group. Although nonoperative management was successful in 72% of the NB group, surgery was performed for most (62%) of the BAR group (P <.01). The BAR group was more likely to undergo laparoscopy (5% versus 2%) and abdominal wall reconstruction (38% versus 9%) and less likely to undergo ostomy (1% versus 13%) or colon resection (2% versus 9%, all P <.01). The BAR patients underwent surgery within an average of 24 hours compared with 3.3 days for the NB group (P <.01). Despite the increased rate of urgent surgery, the BAR group had a significantly shorter length of stay (4 versus 7 days), fewer complications (25% versus 44%), and lower mortality rate (.5% versus 3.5%).


CONCLUSIONS
Bowel obstruction is a common and complex problem for patients who have undergone bariatric surgery. The management algorithms should consider the significant differences in the cause of obstruction and the need for early operative intervention in this special patient population.
Department of Surgery, Bariatric Surgical Service, Madigan Army Medical Center, Tacoma, Washington, 98431, USA. matthew.martin1@amedd.army.mil
Matthew J
MJ
Martin
Alec C
AC
Beekley
James A
JA
Sebesta
D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014861:Washington / Q000453:epidemiology