M. Khalil1, T. Orouji Jokar1, H. Nerkar1 1New York Medical College,General Surgery,Brooklyn, NY, USA 2New York Medical College,General Surgery,Brooklyn, NY, USA
Introduction: Over the past few years the mangaement of small bowel obstruction (SBO) has been transitioned from operative to non-operative management. Furthermore, with increasing expertise in the laparoscopy, an increased use has been observed in emergent cases. The aim of this study was to assess the temporal trends in the management of SBO and outcomes differences of open versus laparascopic adhesiolysis.
Methods: We performed a five year (2008-2012) retrospective analysis of national inpatient sample. We identified patient with SBO using ICD-9 diagnosis codes for small bowel obstructin with concomitant codes for intra-abdominal or peritoneal lysis of adhesions, gangrenous or obstructed hernia, or small bowel malignancy. Open adhesiolysis was identified using procedure code 54.59 and laparoscopic adhesioslysis was identified using 54.51 and 54.21. Our outcomes were trends in operative versus non-operative management of SBO and differences in outcomes between open versus laparosopic adhesiolysis.
Results: A total of 503974 patients with SBO were identified, mean age of population was 48 (27) years, and 58% were female. There was no significant increase in total number of SBO over the years (p=0.68). The rate of operative intervention gone down significantly from 21% to 19% over the years (p<0.001). The total hospital charges and length of stay (LOS) was significantly lower in non-operative management (p<0.001 for both inferences). On comparison between open and laparoscopic adhesiolysis, the rate of open adhesiolysis decreased from 81% to 76% (p<0.001). The total LOS (p<0.001) and hospital charges (p<0.001) were significantly lower in laparoscopic group.
Conclusion: The non-operative management appears to be the favored treatment strategy in the management of SBO. However, in the sub-group of patient who require surgery, there has been an increasing role of laparoscopy. Further studies are warranted to better define these outcomes differences.