Toneman MK, de Kok BM, Zijta FM, Oei S, van Acker GJD, Westerterp M, van der Pool AEM. Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics. World J Gastrointest Surg 2022; 14(6): 556-566 [PMID: 35979424 DOI: 10.4240/wjgs.v14.i6.556]
Corresponding Author of This Article
Masja K Toneman, Doctor, Department of Surgery, Haaglanden Medical Centre, Lijnbaan 32, The Hague 2512 VA, Netherlands. mktoneman@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
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Toneman MK, de Kok BM, Zijta FM, Oei S, van Acker GJD, Westerterp M, van der Pool AEM. Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics. World J Gastrointest Surg 2022; 14(6): 556-566 [PMID: 35979424 DOI: 10.4240/wjgs.v14.i6.556]
World J Gastrointest Surg. Jun 27, 2022; 14(6): 556-566 Published online Jun 27, 2022. doi: 10.4240/wjgs.v14.i6.556
Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics
Masja K Toneman, Bente M de Kok, Frank M Zijta, Stanley Oei, Gijs J D van Acker, Marinke Westerterp, Anne E M van der Pool
Masja K Toneman, Gijs J D van Acker, Marinke Westerterp, Anne E M van der Pool, Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
Bente M de Kok, Frank M Zijta, Stanley Oei, Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
Author contributions: Toneman MK, de Kok BM, Zijta FM, Oei S, van Acker GJD, Westerterp M and van der Pool AEM designed the report; Toneman MK collected the patient’s clinical data, analyzed the data and wrote the paper; de Kok BM, Zijta FM, Oie S, van Acker GJD, Westerterp M and van der Pool AEM revised the paper for important intellectual content; van der Pool AE supervised the report.
Institutional review board statement: The Institutional Review Board of Haaglanden Medical center provided approval for this study, No. 2018-105.
Informed consent statement: The scientific board of our hospital approved the study. Because the law on medical scientific research concerning humans was not applicable due of the non-invasive and retrospective nature of the study, the need for written informed consent was waived. However, it was required that every patient file was checked for notes of refusal to participate in scientific research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The corresponding author (Masja K Toneman, mktoneman@gmail.com) of this article is available for contact about the dataset, which is anonymized. The keyfile to translate to patients is available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Masja K Toneman, Doctor, Department of Surgery, Haaglanden Medical Centre, Lijnbaan 32, The Hague 2512 VA, Netherlands. mktoneman@gmail.com
Received: July 28, 2021 Peer-review started: July 28, 2021 First decision: September 5, 2021 Revised: September 24, 2021 Accepted: June 17, 2022 Article in press: June 17, 2022 Published online: June 27, 2022 Processing time: 334 Days and 3.2 Hours
Abstract
BACKGROUND
Closed-loop small bowel obstruction (CL-SBO) can threaten the viability of the intestine by obstructing a bowel segment at two adjacent points. Prompt recognition and surgery are crucial.
AIM
To analyze the outcomes of patients who underwent surgery for CL-SBO and to evaluate clinical predictors.
METHODS
Patients who underwent surgery for suspected CL-BSO on computed tomography (CT) at a single center between 2013 and 2019 were evaluated retrospectively. Patients were divided into three groups by perioperative outcome, including viable bowel, reversible ischemia, and irreversible ischemia. Clinical and laboratorial variables at presentation were compared and postoperative outcomes were analyzed.
RESULTS
Of 148 patients with CL-SBO, 28 (19%) had a perioperative viable small bowel, 86 (58%) had reversible ischemia, and 34 (23%) had irreversible ischemia. Patients with a higher age had higher risk for perioperative irreversible ischemia [odds ratio (OR): 1.03, 95% confidence interval (CI): 0.99-1.06]. Patients with American Society of Anaesthesiologists (ASA) classification ≥ 3 had higher risk of perioperative irreversible ischemia compared to lower ASA classifications (OR: 3.76, 95%CI: 1.31-10.81). Eighty-six patients (58%) did not have elevated C-reactive protein (> 10 mg/L), and between-group differences were insignificant. Postoperative in-hospital stay was significantly longer for patients with irreversible ischemia (median 8 d, P = 0.001) than for those with reversible ischemia (median 6 d) or a viable bowel (median 5 d). Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia (45%, P = 0.043) compared with reversible ischemia (20%) and viable bowel (4%).
CONCLUSION
Older patients or those with higher ASA classification had an increased risk of irreversible ischemia in case of CL-SBO. After irreversible ischemia, postoperative morbidity was increased.
Core Tip: We studied the preoperative characteristics and postoperative outcomes of 148 patients with closed-loop small bowel obstruction, based on the perioperative small bowel viability (viable, reversible ischemia, or irreversible ischemia). Retrospective evaluation found that older age or an American Society of Anesthesiologists classification of 3 or higher increased the risk of perioperative irreversible ischemia. C-reactive protein (CRP) that is not increased above normal levels does not assure the presence of a viable bowel, and 55.83% of patients with ischemia had normal CRP levels. Perioperative irreversible ischemia significantly increased postoperative morbidity. These risks should be mentioned in preoperative consultations.
