title: Effect of omentum removal on the risk for postoperative adhesive small bowel obstruction recurrence: a case-control study.
abstract: BACKGROUND
  Surgical treatment for adhesive small bowel obstructions (ASBOs) is the only way to release the obstructive structure; however, opening the peritoneal cavity may cause new adhesions, possibly leading to recurrent episodes of ASBO. The risk factors for recurrent ASBO, after surgical treatment, are not fully understood.
  
  
  METHODS
  The hospital records of 113 patients undergoing surgery for ASBO at Shirakawa Kousei (Japan) General Hospital, between 2002 and 2013, were studied. We compared the pre- and postoperative factors, intraoperative findings, and surgical histories of 18 patients with and 95 patients without recurrent ASBO. The risk factors for ASBO recurrence, after surgery, were determined using Cox-proportional hazard ratios.
  
  
  RESULTS
  The 5-year cumulative rate of overall recurrence was 20.8%. Among the 18 patients of recurrence, 11 (61.1%) were readmitted within 1 year of surgical treatment. Multivariate analysis revealed that a history of omentectomy was an independent risk factor for recurrence (hazard ratio, 2.98; p = 0.027). After omentectomy, the rate of adhesions to the peritoneum was significantly higher (with omentectomy, 54.5%; without omentectomy, 21.3%; p < 0.001), and the risk of adhesion or matted adhesion was increased (with omentectomy, 87.9%; without omentectomy, 53.8%; p < 0.001), compared with patients not undergoing omentectomy.
  
  
  CONCLUSIONS
  Omentectomy significantly increases the likelihood of ASBO recurrence. Therefore, patients undergoing omentectomy may be candidates for prophylactic anti-adhesion agents, particularly when there is a risk of matted abdominal wall adhesions.
authors.affiliation: Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Japan. Electronic address: ariake@surg1.med.tohoku.ac.jp.
authors.forename: Kyohei
authors.initials: K
authors.lastname: Ariake
authors.affiliation: Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takemura
authors.affiliation: Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Kajiwara
authors.affiliation: Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Japan.
authors.forename: Fusakuni
authors.initials: F
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009852:Omentum / Q000601:surgery*; D010532:Peritoneal Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D000267:Tissue Adhesions
keywords: Adhesive small bowel obstruction; Omentectomy; Risk factor