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Journal of Gastrointestinal Surgery

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01-01-2020 | Constipation | 2019 SSAT Quick Shot Presentation

Parenteral Nutrition Instead of Early Reoperation in the Management of Early Postoperative Small Bowel Obstruction

Authors: Dominykas Burneikis, Luca Stocchi, Ezra Steiger, Denise Jezerski, Sherief Shawki

Published in: Journal of Gastrointestinal Surgery | Issue 1/2020

Abstract

Background

In majority of patients, early postoperative small bowel obstruction (EPSBO) resolves with nasogastric decompression and bowel rest alone, while in some patients, symptoms persist without urgent indications for surgery. The purpose of this study was the evaluation of home parenteral nutrition (HPN) instead of elective surgery as an initial approach to persistent EPSBO.

Methods

Patients developing EPSBO prescribed HPN without reoperation within 6 weeks after index intestinal surgery were identified from an institutional HPN registry and retrospectively compared with patients undergoing reoperation for EPSBO within the same time period.

Results

Thirty-four patients for the HPN group and 27 patients in elective reoperative (REOP) group met the inclusion criteria. In the HPN group, mean interval between surgery and PN initiation was 11 days. HPN duration ranged from 17 to 244 days with a median of 60 days. Thirty-one patients (91%) successfully recovered bowel function and resumed enteral nutrition without reoperation, while 3 patients required reoperation > 6 weeks after index surgery due to HPN failure. In the REOP group, mean interval between index surgery and reoperation was 17 days. At reoperation, 12 patients required bowel resection, 5 having incidental enterotomies, and 3 required new stoma creation. Postoperatively, 2 patients developed enterocutaneous fistulas, 1 experienced an anastomotic leak, and another had fascial dehiscence.

Conclusion

HPN is a safe alternative to elective surgery in clinically stable patients with persistent EPSBO. This approach avoids hazardous reoperation during the recovery phase when adhesions are at their worst.

Sajja SBS, Schein M. Early postoperative small bowel obstruction. Br J Surg. 2004;91(6):683–691. https://doi.org/10.1002/bjs.4589 CrossRefPubMed

Schein M, Sajja SBS. Early Postoperative Small Bowel Obstruction. Semin Colon Rectal Surg. 2005;16(4):228–234. https://doi.org/10.1053/j.scrs.2006.01.011 CrossRef

Pickleman J, Lee RM. The management of patients with suspected early postoperative small bowel obstruction. Ann Surg. 1989;210(2):216–219.CrossRef

Ellozy SH, Harris MT, Bauer JJ, Gorfine SR, Kreel I. Early postoperative small-bowel obstruction: a prospective evaluation in 242 consecutive abdominal operations. Dis Colon Rectum. 2002;45(9):1214–1217. https://doi.org/10.1097/01.DCR.0000027036.19626.F0 CrossRefPubMed

Goussous N, Kemp KM, Bannon MP, et al. Early postoperative small bowel obstruction: Open vs laparoscopic. Am J Surg. 2015;209(2):385–390. https://doi.org/10.1016/j.amjsurg.2014.07.012 CrossRefPubMed

Fraser SA, Shrier I, Miller G, Gordon PH. Immediate postlaparotomy small bowel obstruction: a 16-year retrospective analysis. Am Surg. 2002;68(9):780–782.PubMed

Lorenz EPM, Zühlke HV, Lange R, Savvas V. Pathophysiology and Classification of Adhesions. In: Peritoneal Adhesions. Springer, Berlin, Heidelberg; 1997:29–34. https://doi.org/10.1007/978-3-642-60433-1_4 CrossRef

Gong J-F, Zhu W-M, Yu W-K, Li N, Li J-S. Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis. World J Gastroenterol. 2013;19(46):8722–8730. https://doi.org/10.3748/wjg.v19.i46.8722 CrossRefPubMedPubMedCentral

Selby RR, Mertz GH, Gilsdorf RB. Spontaneous resolution of intestinal obstruction while receiving home parenteral nutrition. Am J Surg. 1983;146(6):742–745. https://doi.org/10.1016/0002-9610(83)90331-8 CrossRefPubMed

10.

Quatromoni JC, Rosoff L, Halls JM, Yellin AE. Early postoperative small bowel obstruction. Ann Surg. 1980;191(1):72–74.CrossRef

11.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010 CrossRefPubMed

12.

Clavien PA, Barkun J, De O, et al. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMed

13.

Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentral

14.

John BK, Khan MA, Speerhas R, et al. Ethanol lock therapy in reducing catheter-related bloodstream infections in adult home parenteral nutrition patients: Results of a retrospective study. J Parenter Enter Nutr. 2012;36(5):603–610. https://doi.org/10.1177/0148607111428452 CrossRef

15.

Freemantle N, Marston L, Walters K, Wood J, Reynolds MR, Petersen I. Making inferences on treatment effects from real world data: propensity scores, confounding by indication, and other perils for the unwary in observational research. BMJ. 2013;347:f6409. https://doi.org/10.1136/bmj.f6409 CrossRefPubMed

Title: Parenteral Nutrition Instead of Early Reoperation in the Management of Early Postoperative Small Bowel Obstruction
Authors: Dominykas Burneikis
Luca Stocchi
Ezra Steiger
Denise Jezerski
Sherief Shawki
Publication date: 01-01-2020
Publisher: Springer US
Keywords: Constipation
Nutrition
Ileostomy
Constipation
Published in: Journal of Gastrointestinal Surgery / Issue 1/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04347-1

At a glance: The STEP trials

Springer Medicine

Parenteral Nutrition Instead of Early Reoperation in the Management of Early Postoperative Small Bowel Obstruction

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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