Risk factor for small bowel obstruction after appendectomy

Abstract

Background: Adhesions are the most frequent complication in abdominal surgery and are one of the biggest unresolved issues in contemporary medicine. Acute appendicitis is one of the most frequent surgical diseases in general, and of surgical abdominal inflammations requiring surgical treatment, acute appendicitis surely has the leading role. The aim of this study was to identify the risk factors for small bowel obstruction after appendectomy. 

Methods: In period 2006-2011, we followed up 1500 patients who had surgery at the Surgery Clinic of the University Clinical Centre in Tuzla, due to acute appendicitis, 46 of which are re-admitted and operated due to post-operative small bowel adhesions. The patients' follow-up period was minimum 6 months to maximum 5 years.

Results: The analysis of risk factors and post-operative small bowel obstructions after appendectomy showed that the following parameters significantly increased the chances for post-operative small bowel obstructions caused by adhesions: peritonitis (OR:27,2), number of previous surgeries ≥2 (OR:14,86), intra-abdominal drain (OR:5,2), men (OR:3,1), ASA score ≥3 (OR:2,6) . In total prediction model, it was determined with multivariate regression analysis that only the presence of intra-abdominal drain and peritonitis are the best independent predictors for post-operative small bowel obstructions after appendectomy

Conclusion: Postoperative peritoneal adhesions are a major health problem with a significant economic impact. Until additional findings from future clinical studies, only meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery

Key words: small bowel obstruction, appendectomy