Comparison of 6-Year Outcomes after Open Surgery, Successful Laparoscopic Adhesiolysis, and Non-Operative Management of Adhesive Small Bowel Obstruction

Objective. To compare short- and long-term outcomes of open surgery, laparoscopic adhesiolysis and non-operative management in patients with adhesive small bowel obstruction. Material and methods. A multiple-center retrospective cohort study included 366 patients with small bowel obstruction (SBO) treated across seven hospitals in Moscow. All patients were hospitalized between 01/01/2017 and 12/31/2019. Primary endpoints were overall survival and mean life expectancy (MLE) over 6 years after initial hospitalization, cumulative probability of rehospitalization and surgery at rehospitalization, mean duration of index hospitalization, mean duration of a single hospitalization and overall hospital-stay per a patient over 6 years. Statistical analysis included Kaplan—Meier survival analysis, Aalen—Johansen estimator, Markov modeling, Cox proportional hazards regression, log-rank test, Gray’s test, Fisher’s exact test, and Welch’s t-test. Results. At index hospitalization, non-operative management (NOM) was successful in 228 patients (62%). Open surgery (OS) was performed in 87 patients (24%) and laparoscopic adhesiolysis (LA) in 51 patients (14%). Over subsequent 6-year follow-up, 94 (26%) patients died, and 67 (19%) patients were re-hospitalized with recurrent small bowel obstruction. Of these, 17 (5%) ones underwent surgery. Over 6 years, MLE did not differ significantly between the LA and NOM groups. However, it was significantly longer compared with the OS group (by 12.7 months (95% CI: 4.2—21.2; p<0.001) and 13.8 months (95% CI: 3.7—23.8; p=0.003), respectively). The risk of SBO recurrence (rehospitalization) after NOM was higher by 5.26 times (95% CI: 1.54—16.7; p=0.004) and after OS by 3.76 times (95% CI: 1.01—13.97; p=0.046) compared to LA. Mean total hospital-stay over 6 years was significantly shorter after LA and NOM compared to OS (by 6.2 days (95% CI: 1.1—8.9; p=0.011) and 6.1 days (95% CI: 1.8—8.0; p=0.002), respectively). Cumulative probability of surgery at rehospitalization did not differ significantly (p=0.229). Conclusion. Six-year survival of patients with SBO was better after NOM and LA compared to OS. Recurrence of SBO was more common after NOM and OS.