Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background

Closed-loop small bowel obstruction (CL-SBO) can threaten the viability of the intestine by obstruction of a bowel segment at two adjacent points. Prompt recognition of CL-SBO, followed by surgery, is crucial. Clinical predictors of perioperative ischemia and postoperative outcome have not been previously analyzed in a cohort as large as this one.

Research motivation

To date, most studies have evaluated patients with SBOs by comparing surgical vs conservative treatments. Studies for CL-SBOs have mostly focused on aspects of computed tomography imaging. The perioperative findings of previous studies vary and there is often a lack information on the postoperative outcomes.

Research objectives

The aim of this study was to analyze perioperative characteristics and postoperative outcomes of patients with surgery for CL-SBO and to evaluate clinical predictors.

Research methods

The medical records of a cohort of 148 patients who underwent surgery for CL-SBO were analyzed retrospectively. Univariate analysis was performed to identify clinical characteristics that were associated with specific perioperative outcomes. The odds ratios for those that were significantly associated with outcomes were analyzed by logistic regression.

Research 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. Median age and American Society of Anesthesiologists (ASA) classification were significantly higher in patients with irreversible ischemia (P = 0.042 and 0.008, respectively). Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia (45%, P = 0.043) than in those with reversible ischemia (20%) and a viable bowel (4%).

Research conclusions

Older patients and those with an ASA classification ≥ 3 had an increased risk of irreversible ischemia. C-reactive protein within the normal range did not ensure the absence of ischemia. After irreversible ischemia, postoperative morbidity was increased.

Research perspectives

The study results are relevant to preoperative informed consent procedures in patients with CL-SBO. Close attention should be paid to patients with perioperative ischemia for the prompt detection of postoperative complications.