INTESTINAL OCCLUSION DUE TO BRIDLES AND A DHERENCES - ANALYSIS OF 157OPERATED CASES

We retrospectively studied a series of 157 patients who were operated for post-operative occlusion of the small bowel. Our aim was to analyz e the clinical and operative aspects with particular emphasis of the f actors predicting intestinal necrosis. We also reviewed the literature . There were 103 females and 54 males with a mean age of 61 and 51 yea rs respectively (p<0.01). Patients with neoplasia, hernia or irradiate d bowel syndrome were excluded. Perioperative variabled were analyzed and compared with the incidence of intestinal necrosis and post-operat ive morbidity and mortality. Data were compared with the chi2 test. Th e most frequent prior surgery was appendectomy (33 %) and pelvic opera tions (25 %). The mean latency period was 15 years and 5 patients (3 % ) developed immediat post-operative occlusion (mean 7 days). The preop erative interval was 24 hours on the average. The pathologies involved were : bridles 48 %, bridles + adherences 35 %, adherences 17 %. No c linical sign could distinquish between these three categories, but str angulation was more frequent in patients with bridles (p<0.003). The f ollowing factors were significantly related to intestinal necrosis : s igns of abdominal defence (p<0.0002), white-cell-count > 16000 (p<0.00 2), systolic hypotension (p<10(-7)) and the lack of a history of occlu sion (p<0.04). Mortality was 6 % (all at age > 70 years). Age was the only factor significantly related to morbidity-mortality. Emergency su rgery should be performed for patients at risk of intestinal necrosis, especially elderly patients. The incidence of this pathology, its cos t and the important morbidity-mortality could be lowered through adequ ately applied careful surgical procedure in order to limit ischaemia, and peritoneal trauma and haemorrhage. The role of laparoscopic surger y as an alternative generating fewer adherences must be defined.