title: Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery.
abstract: OBJECTIVE
  Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO.
  
  
  METHODS
  This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems.
  
  
  RESULTS
  During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P= .16; hazards ratio (HR) 1.4 95% CI 0.82-2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P= .039; HR 2.82; 95% CI 0.78-8.51). Stoma formation was an independent risk factor for development of SBO (P= .049; HR, 0.63; 95% CI 0.39-1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P= .0003; HR, 2.85; 95% CI 1.44-5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P= .0001).
  
  
  CONCLUSIONS
  The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention.
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Smolarek
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Shalaby
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Paolo Angelucci
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Missori
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Capuano
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Franceschilli
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Quaresima
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult