title: Clinical outcome in acute small bowel obstruction after surgical or conservative management.
abstract: BACKGROUND
  Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO.
  
  
  METHODS
  The outcomes of all patients hospitalized at a single center for acute SBO between 2004 and 2007 were assessed. The occurrence of recurrent hospitalization, surgery, SBO symptoms at home, and mortality was determined.
  
  
  RESULTS
  Among 221 patients admitted with SBO, 136 underwent a surgical procedure (surgical group) and 85 were managed conservatively (conservative group). Baseline characteristics were similar between treatment groups. The median follow-up time (interquartile range) was 4.7 (3.7-5.8) years. Nineteen patients (14.0 %) of the surgical group were hospitalized for recurrent SBO versus 25 (29.4 %) of the conservative group [hazard ratio (HR), 0.5; 95 % CI, 0.3-0.9]. The need for a surgical management of a new SBO episode was similar between the two groups, ten patients (7.4 %) in the surgical group and six patients (7.1 %) in the conservative group (HR, 1.1; 95 % CI, 0.4-3.1). Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1). A follow-up evaluation was obtained for 130 patients. Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8).
  
  
  CONCLUSIONS
  The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.
authors.affiliation: Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland, Raphael.Meier@hcuge.ch.
authors.forename: Raphael P H
authors.initials: RP
authors.lastname: Meier
authors.forename: Wassila Oulhaci
authors.initials: WO
authors.lastname: de Saussure
authors.forename: Lorenzo A
authors.initials: LA
authors.lastname: Orci
authors.forename: Eveline M
authors.initials: EM
authors.lastname: Gutzwiller
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Frédéric
authors.initials: F
authors.lastname: Ris
authors.forename: Frank
authors.initials: F
authors.lastname: Schwenter
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D007421:Intestine, Small / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010359:Patient Readmission; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology