DOES THE INDEX OPERATION INFLUENCE THE COURSE AND OUTCOME OF ADHESIVEINTESTINAL-OBSTRUCTION

Objective: To ascertain the incidence of obstruction after various ope rations and find out if the index operation influenced the course and outcome of adhesive small bowel obstruction. Design: Retrospective stu dy. Setting: Teaching hospital, Israel. Subjects: 190 of 248 patients who presented with small bowel obstruction between January 1980 and De cember 1994. Interventions: All patients were treated conservatively a nd operated on only if they did not improve or deteriorated. Main outc ome measures: Incidence of obstruction depending on site of index oper ation, and response to treatment. Results: 46 Patients (24%) had under gone upper abdominal operations, 26 (14%) small bowel resection, 47 (2 5%) appendicectomy, 27 (14%) gynaecological operations, and 44 (23%) c olonic resections. The annual incidence of obstructive complications a mong the 190 patients in the groups studied was highest after appendic ectomy (3.1/year) and colonic resections (2.9/year) and lowest after o perations on the gallbladder and pancreas (1.1/year). Postoperative ad hesive obstruction presented earlier after operations on the small bow el (median 1 year, range 5.4-20) and colon (median 1 year, range 2.2-4 0) than after the other operations. 60 (32%) of patients with acute sm all bowel obstruction had a history of abdominal malignancy, and obstr uction was more likely to be complete after small bowel resection (20/ 26, 77%) compared with 39/74 (53%) after appendicectomy or gynaecologi cal surgery, 17/46 (37%) after upper abdominal surgery, and 15/44 (34% ) after colonic resection. Patients who developed obstruction after co lonic resection had the longest period of conservative treatment (medi an 60 hours, range 24-216) and had the highest morbidity (8/44, 18%) a lthough only 2 required bowel resection. Two patients died, both after obstruction following upper abdominal operations. Conclusions: Patien ts who present with obstruction after small bowel resection are extrem ely likely to be completely obstructed. Perhaps the morbidity associat ed with obstruction after colonic resection could be reduced if patien ts were operated on earlier.