Factors predicting the recurrence of adhesive small-bowel obstruction

A long-standing debate exists about whether stable patients who have adhesive small-bowel obstruction (ASBO) are best managed operatively or nonoperatively. In addition, the factors that predict recurrence have not been established. We conducted a retrospective cohort study using medical records of 31 ASBO patients managed operatively and 59 managed nonoperatively. Follow-up data for up to 12.8 years after the index ASBO were collected from medical records. Life-table analyses found that ASBO recurred after 53% of initial episodes and 85% or more of second, third, or later episodes. Recurrence was much more rapid after third or later episodes than after first or second episodes. Recurrence occurred sooner and more frequently in patients managed nonoperatively than in patients managed operatively. These differences became statistically significant only after the second episode. The number of prior episodes is the strongest predictor of recurrence. The optimal management strategy is a function of the number of prior episodes a patient has experienced. Nonoperative management appears reasonable for stable patients who are having their first episode. Operative strategies appear best for those experiencing second episodes. Neither strategy yields acceptable outcomes in patients experiencing third or later episodes.