• Annals of surgery · Feb 2025

    Recurrence Following Operative vs. Non-Operative Management of Adhesive Small Bowel Obstruction in Children: A Multi-center Prospective Observational Study.

    • Utsav M Patwardhan, Romeo C Ignacio, Kaci Pickett-Nairne, Katie W Russell, Justin Lee, Ben Padilla, Caroline Melhado, Lorraine I Kelley-Quon, David H Rothstein, Hariharan Thangarajah, Ana Ibarra-Meraz, Rabab M Barq, Kezlyn E Larsen, Kathryn L Fowler, Zebediah Hunteman, Maria Valencia-Bradd, Katrine Lofberg, Aaron Jensen, Samir Pandya, Shannon N Acker, and Western Pediatric Surgery Research Consortium.
    • Division of Pediatric Surgery, Rady Children's Hospital San Diego.
    • Ann. Surg. 2025 Feb 10.

    ObjectiveData on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to non-operative management (NOM).MethodsWe conducted a prospective observational study of children with ASBO admitted to nine hospitals from 10/2020 to 12/2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.ResultsAmong 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, twenty patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs. 6.1%, P=0.04). However, after adjusting for age (HR 0.35, CI 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.ConclusionAlthough the rate of recurrent ASBO in children is nearly 15% within one year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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