Predictive Factor for Surgical Indication in Postoperative Adhesive Small Bowel Obstruction

Purpose: There is a long-standing debate about whether postoperative adhesive small bowel obstruction (SBO) is best managed operatively or nonoperatively. The aim of this study is to define predictive factors for surgical indication in the treatment of an adhesive SBO. Methods: Medical records and laboratory data of 211 patients who had a SBO after a laparotomy from January 2000 to December 2008 were reviewed retrospectively. The patients were divided into two groups according to the modality of SBO treatment: operatively and nonoperatively. The laboratory data and clinical parameters were compared between the two groups and a statistical analysis was performed. Results: A Mann-Whitney analysis revealed previous SBO history, amylase, erythrocyte sedimentation rate (ESR), creatine phosphokinase, drainage amount via a Levin tube to be significant factors associated with surgical management. A multivariate analysis showed drainage amount via a Levin tube of 500 mL/day or greater (P=0.007), amylase of 90 IU/L or greater (P= 0.04), and ESR of 11 mm/hr or greater (P=0.03) to be independent predictive factors for surgery. Conclusion: Surgical management should be considered among adhesive SBO patients with elevated amylase (90 IU/L) and ESR (11 mm/hr) and with large drainage amount through the Levin tube (500 mL/day).