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Can Adhesiolysis During Surgery Could Cause Bowel Injury?
Question: Hello doctor !
At first thank you ver much for your help !
The last our discussion was closed - so i ask here !~
So in short answer is the best from you point by point !
1. adhesiolysis during surgery could cause bowel injury in 2012 very big study rate as 6 %
Use of adhesiolysis
resulted in a 6% (4% to 8%; I
2=89%) incidence of iatrogenic bowel injury.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
As we discussed now days this rate could be even lower - as technique is better
So hernia reoperation with prior mesh now days could have bowel injury rate 6 % and lower bowel injury rate
2. Even bowel injury occur during surgery - late recognition have low mortality rate 3%. In conclusion even bowel injury occur outcome is good
, making the mortality rate for
unrecognized bowel injury 5 in 154 or 1 in 31 (3.2%,
95% CI 1–7%).
https://sci-hub.hkvisa.net/10.1097/aog.0000
3. As understand most people who have adhesion dont need treatment them !
Only less than 5%
Is it so ?
Thank you very much !
At first thank you ver much for your help !
The last our discussion was closed - so i ask here !~
So in short answer is the best from you point by point !
1. adhesiolysis during surgery could cause bowel injury in 2012 very big study rate as 6 %
Use of adhesiolysis
resulted in a 6% (4% to 8%; I
2=89%) incidence of iatrogenic bowel injury.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
As we discussed now days this rate could be even lower - as technique is better
So hernia reoperation with prior mesh now days could have bowel injury rate 6 % and lower bowel injury rate
2. Even bowel injury occur during surgery - late recognition have low mortality rate 3%. In conclusion even bowel injury occur outcome is good
, making the mortality rate for
unrecognized bowel injury 5 in 154 or 1 in 31 (3.2%,
95% CI 1–7%).
https://sci-hub.hkvisa.net/10.1097/aog.0000
3. As understand most people who have adhesion dont need treatment them !
Only less than 5%
Is it so ?
Thank you very much !
Brief Answer:
As detailed.
Detailed Answer:
Thanks for your belief in me, will try to cover all in short.
3> Only those cases who have symptoms due to adhesion - like bowel obstruction due to stricture or kinking causing distention/bloating, vomiting, constipation/obstipation (unable to pass gas and stool) and pain alone may need surgery if 3 days of medical management fails to relieve the symptoms.
2> No, earlier recognition have better chances of less complications.
1> Adhesiolysis: Older the surgeon, lesser are the complications as he has learned a lot and many a times sixth-sense develops over time. Many a times unexpected results in either way are seen, say no problem with the best recovery in a patient where we anticipated complications and vise versa.
I have answered in reverse, I hope this helps. Please feel free to ask for further relevant queries.
Dr T Chandrakant
As detailed.
Detailed Answer:
Thanks for your belief in me, will try to cover all in short.
3> Only those cases who have symptoms due to adhesion - like bowel obstruction due to stricture or kinking causing distention/bloating, vomiting, constipation/obstipation (unable to pass gas and stool) and pain alone may need surgery if 3 days of medical management fails to relieve the symptoms.
2> No, earlier recognition have better chances of less complications.
1> Adhesiolysis: Older the surgeon, lesser are the complications as he has learned a lot and many a times sixth-sense develops over time. Many a times unexpected results in either way are seen, say no problem with the best recovery in a patient where we anticipated complications and vise versa.
I have answered in reverse, I hope this helps. Please feel free to ask for further relevant queries.
Dr T Chandrakant
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Could you please direct answer to my questions !
So i understand
1. So study - bowel injuries occurred reoperation population at rate 6 % adhesiolysis during surgery
This study in period 1990 - 2010 period
www.ncbi.nlm.nih.gov
as you said now day technique is better so bowel injury rate is even lover than 6 % !
Just simply say yes - and that's all
2. I know that bowel injury's late diagnose cause complications, but the mortality rate is rather low 3%
That's what i means that surviving rate is 97%. ( Good outcome by low mortality rate )
Just say Yes
3. So as those who have adhesion - surgery is needed in case when bowel obstruction occurs
So lower than 5 % of people with adhesion need surgery !
Just say yes - and that's all
4. Comparing rates of bowel injury for laparoscopic and robotic ventral
hernia repair
As overall rete of bowel inquiry was low 1,3 % and prior mesh increase risk only 1.3 times
The recurrence for incisional hernia mathematical is 1,69 % - that is very much lower than in from article in early 2000 where bowel injury risk for reoperative prior mesh cause 20 % bowel injury -
In new study only 1.69 %
So in conclusion now day bowel injury rate has dropped down very good
Just say yes and that's all
Bowel injury occur at rate bowel injuries were identified [1.3%] laparoscopic vs. 54 [0.8%] robotic
patients with prior mesh are more likely to have a bowel
injury, this is not statistically signifcant (OR 1.326 [95%
https://static-content XXXXXXX com/pdf/art%3A10.1007%2Fs10029-022-02564-3.pdf?token=0000--554bae89c3757f61ff699e11b745178ea523b207c0bd2ac76e3dfa1dbb61f807ca952eb54aecf22c0d1b7ea3f5eb698fe3b6c3787da255d124d8cf11d43f56b2
https://link XXXXXXX com/article/10.1007/s10029-022-02564-3
Thank you
So i understand
1. So study - bowel injuries occurred reoperation population at rate 6 % adhesiolysis during surgery
This study in period 1990 - 2010 period
www.ncbi.nlm.nih.gov
as you said now day technique is better so bowel injury rate is even lover than 6 % !
Just simply say yes - and that's all
2. I know that bowel injury's late diagnose cause complications, but the mortality rate is rather low 3%
That's what i means that surviving rate is 97%. ( Good outcome by low mortality rate )
Just say Yes
3. So as those who have adhesion - surgery is needed in case when bowel obstruction occurs
So lower than 5 % of people with adhesion need surgery !
Just say yes - and that's all
4. Comparing rates of bowel injury for laparoscopic and robotic ventral
hernia repair
As overall rete of bowel inquiry was low 1,3 % and prior mesh increase risk only 1.3 times
The recurrence for incisional hernia mathematical is 1,69 % - that is very much lower than in from article in early 2000 where bowel injury risk for reoperative prior mesh cause 20 % bowel injury -
In new study only 1.69 %
So in conclusion now day bowel injury rate has dropped down very good
Just say yes and that's all
Bowel injury occur at rate bowel injuries were identified [1.3%] laparoscopic vs. 54 [0.8%] robotic
patients with prior mesh are more likely to have a bowel
injury, this is not statistically signifcant (OR 1.326 [95%
https://static-content XXXXXXX com/pdf/art%3A10.1007%2Fs10029-022-02564-3.pdf?token=0000--554bae89c3757f61ff699e11b745178ea523b207c0bd2ac76e3dfa1dbb61f807ca952eb54aecf22c0d1b7ea3f5eb698fe3b6c3787da255d124d8cf11d43f56b2
https://link XXXXXXX com/article/10.1007/s10029-022-02564-3
Thank you
Brief Answer:
As detailed.
Detailed Answer:
Different studies show different results hence we can not count in percentage. It all depends upon many factors.
1> Different studies have different results.
2> I can not take onus of percentage. So sorry for this.
3> Mostly yes
4> Robotic surgery is actually done by a Surgeon who sits on the console- the difference is best instruments that have better motility but the surgeon needs to be really conversant with.
I was wondering why would you undergo such details.
Please elaborate.
Take care.
As detailed.
Detailed Answer:
Different studies show different results hence we can not count in percentage. It all depends upon many factors.
1> Different studies have different results.
2> I can not take onus of percentage. So sorry for this.
3> Mostly yes
4> Robotic surgery is actually done by a Surgeon who sits on the console- the difference is best instruments that have better motility but the surgeon needs to be really conversant with.
I was wondering why would you undergo such details.
Please elaborate.
Take care.
Above answer was peer-reviewed by :
Dr. Kampana
Thank you
1. The death rate for unrecognized bowel was from literature 3% - so in concluded that it is not so bad (as i always try to think positive)
Furthermore, all of the deaths reported in these series
occurred as a result of delayed recognition of bowel
injury (n5154), making the mortality rate for unrecognized bowel injury 5 in 154 or 1 in 31 (3.2%, 95%
CI 1–7%). There were no deaths associated with intraoperatively diagnosed bowel injury
https://sci-hub.hkvisa.net/10.1097/aog.0000
2. When small bowel obstruction due to adhesions resection is needed stoma is needed rare - when its is needed when large amount of bowel is respected ? Or there are some other risk factors for that ? And these stoma most cases are temporary - as i understand !
A stoma was created in 63 patients (1⋅3 per cent) who
required surgery -
https://sci-hub.hkvisa.net/10.1002/bjs.11284
3. The risk of a groin hernia becoming incarcerated or strangulated is estimated between 1% to 3% over a person’s lifetime.
https://www.ncbi.nlm.nih.gov/books/NBK555972/
So the most common groin hernia wont cause any problems ?
Thank you
1. The death rate for unrecognized bowel was from literature 3% - so in concluded that it is not so bad (as i always try to think positive)
Furthermore, all of the deaths reported in these series
occurred as a result of delayed recognition of bowel
injury (n5154), making the mortality rate for unrecognized bowel injury 5 in 154 or 1 in 31 (3.2%, 95%
CI 1–7%). There were no deaths associated with intraoperatively diagnosed bowel injury
https://sci-hub.hkvisa.net/10.1097/aog.0000
2. When small bowel obstruction due to adhesions resection is needed stoma is needed rare - when its is needed when large amount of bowel is respected ? Or there are some other risk factors for that ? And these stoma most cases are temporary - as i understand !
A stoma was created in 63 patients (1⋅3 per cent) who
required surgery -
https://sci-hub.hkvisa.net/10.1002/bjs.11284
3. The risk of a groin hernia becoming incarcerated or strangulated is estimated between 1% to 3% over a person’s lifetime.
https://www.ncbi.nlm.nih.gov/books/NBK555972/
So the most common groin hernia wont cause any problems ?
Thank you
Brief Answer:
As detailed.
Detailed Answer:
Hi.
To answer your specific questions.
3 > Groin Hernia: Yes and mostly the patient is responsible due to irresponsible behavior. Otherwise no problems except discomfort and difficulty in day-to-day if the hernia is not operated and becomes very large.
2> yes
1> truly yes.
I hope this helps.
Please feel free to ask further relevant queries if you feel that there is a gap of communication.
As detailed.
Detailed Answer:
Hi.
To answer your specific questions.
3 > Groin Hernia: Yes and mostly the patient is responsible due to irresponsible behavior. Otherwise no problems except discomfort and difficulty in day-to-day if the hernia is not operated and becomes very large.
2> yes
1> truly yes.
I hope this helps.
Please feel free to ask further relevant queries if you feel that there is a gap of communication.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Tank you very much for your support -
1. So stoma in small bowel obstruction is needed whet there is some other healt conditions like cancer ...that effect large amount of bowel - i read it from literature.
2. The question about paraumbilical hernia - it is common asymptomatic - and it is diagnosed with high resolution Ultrasonography -
The question paraumbilical hernia with no symptoms and with no XXXXXXX those containing bowel in the hernia
Incarnation risk is low ? ( I am afraid about my parents and old relatives - as paraumbilical hernia is common in these people but often asymptomatic ) - so if my parents have no symptoms or visual XXXXXXX of paraumbilical hernia the incarnation and strangulation risk is low ?
There was one study about follow up - they was asymptomatic but it was not said if there was visual XXXXXXX of hernia
3.5 % (n = 10) of the asymptomatic
patients received emergency repair
https://sci-hub.se/10.1007/s10029-016-1464-z
3. Question about inguinal hernia repair and Testicular atrophy - as i understate it should be monitoring early
2 - 3 days after symptom pain and redness in testicles - Testicular ultrasonography and Doppler diagnoses
And treatment is removing mesh ? Or other treatment ?
Thank you
1. So stoma in small bowel obstruction is needed whet there is some other healt conditions like cancer ...that effect large amount of bowel - i read it from literature.
2. The question about paraumbilical hernia - it is common asymptomatic - and it is diagnosed with high resolution Ultrasonography -
The question paraumbilical hernia with no symptoms and with no XXXXXXX those containing bowel in the hernia
Incarnation risk is low ? ( I am afraid about my parents and old relatives - as paraumbilical hernia is common in these people but often asymptomatic ) - so if my parents have no symptoms or visual XXXXXXX of paraumbilical hernia the incarnation and strangulation risk is low ?
There was one study about follow up - they was asymptomatic but it was not said if there was visual XXXXXXX of hernia
3.5 % (n = 10) of the asymptomatic
patients received emergency repair
https://sci-hub.se/10.1007/s10029-016-1464-z
3. Question about inguinal hernia repair and Testicular atrophy - as i understate it should be monitoring early
2 - 3 days after symptom pain and redness in testicles - Testicular ultrasonography and Doppler diagnoses
And treatment is removing mesh ? Or other treatment ?
Thank you
Brief Answer:
As detailed
Detailed Answer:
Most welcome.
1> Yes. And to add on - Stoma is created when immediate repair has imminent danger of disruption, saves abdomen and body from infection, helps to improve health of patient to optimum condition when it can be closed.
2> Incarceration and strangulation depends on the size of neck. If small bowel is not allowed but the omental fat can causing discomfort. Large neck can allow bowel with possible complication.
3> This is very rare and needs emergency color doppler and management, if at all it occurs.
I hope this answers your queries.
Have a great day.
Dr T Chandrakant.
As detailed
Detailed Answer:
Most welcome.
1> Yes. And to add on - Stoma is created when immediate repair has imminent danger of disruption, saves abdomen and body from infection, helps to improve health of patient to optimum condition when it can be closed.
2> Incarceration and strangulation depends on the size of neck. If small bowel is not allowed but the omental fat can causing discomfort. Large neck can allow bowel with possible complication.
3> This is very rare and needs emergency color doppler and management, if at all it occurs.
I hope this answers your queries.
Have a great day.
Dr T Chandrakant.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Than you doctor -
1. If paraumbilical hernia is asymtomatic and small no visual sign of hernia ( bowel in the hernia)-
Incarnation risk is low ?
2. If paraumbilical hernia is asymptomatic - but there is visual sign of hernia - it should be treated son as possible as there is risk of incarnation. Is it so ?
3. Should my parents go to ultrasonography for possible paraumbilical hernia - if they have no symptoms or visual change in their abdominal ?
Or the risk of paraumbilical hernia without symptoms and visual XXXXXXX incarnation risk is small !
4. inguinal hernia incarnation risk depends on size of hernia - during the time inguinal hernia become larger and thats why older persons have more risk of incarnation - it seams logic !
But again it depends on size - if the size is large and have symptoms incarnation risk is much bigger - logic !
There are studies 364 patient follow up - 5 years only two had emergency surgery of incarnation
https://sci-hub.se/10.1001/jama.295.3.285
other study there was study 699 patients 10 year follow only two had emergency surgery
https://sci-hub.se/10.1016/s1072-7515(01)00983-8
1. If paraumbilical hernia is asymtomatic and small no visual sign of hernia ( bowel in the hernia)-
Incarnation risk is low ?
2. If paraumbilical hernia is asymptomatic - but there is visual sign of hernia - it should be treated son as possible as there is risk of incarnation. Is it so ?
3. Should my parents go to ultrasonography for possible paraumbilical hernia - if they have no symptoms or visual change in their abdominal ?
Or the risk of paraumbilical hernia without symptoms and visual XXXXXXX incarnation risk is small !
4. inguinal hernia incarnation risk depends on size of hernia - during the time inguinal hernia become larger and thats why older persons have more risk of incarnation - it seams logic !
But again it depends on size - if the size is large and have symptoms incarnation risk is much bigger - logic !
There are studies 364 patient follow up - 5 years only two had emergency surgery of incarnation
https://sci-hub.se/10.1001/jama.295.3.285
other study there was study 699 patients 10 year follow only two had emergency surgery
https://sci-hub.se/10.1016/s1072-7515(01)00983-8
Brief Answer:
as detailed
Detailed Answer:
Thanks for your additional queries.
1> Yes, very low.
2> As said earlier, incarceration depends upon the neck size; small ones can allow only fat and large one that allow bowel can cause this.
3> No risk if hernia is not present. Clinical examination can see if hernia is present, If suspected then only confirmation needed by Ultrasound and to see the size of defect/neck, contents if any.
4> Inguinal hernia: Small neck with large hernia has more chances of complications. Large hernia occupies more fat and bowel and overcrowding may not allow return of contents to abdominal cavity.
As hernia are usually operated in time, complication rate has reduced as you have mentioned so well.
I hope, these answer your queries in short as you have asked for.
Dr T Chandrakant.
General Surgeon.
as detailed
Detailed Answer:
Thanks for your additional queries.
1> Yes, very low.
2> As said earlier, incarceration depends upon the neck size; small ones can allow only fat and large one that allow bowel can cause this.
3> No risk if hernia is not present. Clinical examination can see if hernia is present, If suspected then only confirmation needed by Ultrasound and to see the size of defect/neck, contents if any.
4> Inguinal hernia: Small neck with large hernia has more chances of complications. Large hernia occupies more fat and bowel and overcrowding may not allow return of contents to abdominal cavity.
As hernia are usually operated in time, complication rate has reduced as you have mentioned so well.
I hope, these answer your queries in short as you have asked for.
Dr T Chandrakant.
General Surgeon.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you very much for your help !
So in conclusion !
1.If my parents have no symptoms of paraumbilical heria no of hernia the incarnation risk is very low as you said ! So i should not be woried about my parents !
2. And in this study of paraumbilical hernia there was follow up watch and wait and 3.5 % developed in
And there was coment that there was no very big diffrence of paraumbilical heria size and incarnation risk
This is case where asymptomatic paraumbilical hernia dont show symptoms, but it cause visual sign of paraumbilical hernia ( bowel in the hernia) !
Is it so ?
From our dicsusion it should be like that !
3.5 % (n = 10) of the asymptomatic
patients received emergency repair
https://sci-hub.se/10.1007/s10029-016-1464-z
No significant difference in defect size was found between the WW
patients who underwent emergency repair and the WW
patients who did not undergo emergency repair
https://sci-hub.se/10.1007/s10029-016-1464-z
Thank you very much
So in conclusion !
1.If my parents have no symptoms of paraumbilical heria no of hernia the incarnation risk is very low as you said ! So i should not be woried about my parents !
2. And in this study of paraumbilical hernia there was follow up watch and wait and 3.5 % developed in
And there was coment that there was no very big diffrence of paraumbilical heria size and incarnation risk
This is case where asymptomatic paraumbilical hernia dont show symptoms, but it cause visual sign of paraumbilical hernia ( bowel in the hernia) !
Is it so ?
From our dicsusion it should be like that !
3.5 % (n = 10) of the asymptomatic
patients received emergency repair
https://sci-hub.se/10.1007/s10029-016-1464-z
No significant difference in defect size was found between the WW
patients who underwent emergency repair and the WW
patients who did not undergo emergency repair
https://sci-hub.se/10.1007/s10029-016-1464-z
Thank you very much
Brief Answer:
As detailed
Detailed Answer:
Hi.
Noted your queries.
If there is no hernia - there is no incarceration.
If in doubt, clinical examination by a General Surgeon and Ultrasound to confirm is the rule, whether symptomatic or not.
Incarceration is related to the size of neck. If it allows fat and/or bowel, the possibility of incarceration is there.
Please get it checked.
Otherwise what you say has reference and hence true.
Dr T Chandrakant.
As detailed
Detailed Answer:
Hi.
Noted your queries.
If there is no hernia - there is no incarceration.
If in doubt, clinical examination by a General Surgeon and Ultrasound to confirm is the rule, whether symptomatic or not.
Incarceration is related to the size of neck. If it allows fat and/or bowel, the possibility of incarceration is there.
Please get it checked.
Otherwise what you say has reference and hence true.
Dr T Chandrakant.
Above answer was peer-reviewed by :
Dr. Kampana
Thank you very much for your answers !
The question about gallstones - in all literature it is said that it should be treated if it cause symptoms !
1. The question - should bile duct gallstones treated if they dont cause symptoms - as they have potential to obstruction of XXXXXXX duct, or it depends of other factors
As in all literature it is said that only symptomatic gallstones should be treated - ( as they cause symptoms in other place like bile duct )
2. As i understand - if dille duct obstruction is treated early the outcome is good -
There was one statement in old article
Man ordinarily tolerates mechanical obstruction of the common bile duct fairly well. Death from obstructive jaundice in the first few weeks of its course is quite rare and is only occasionally observed
https://jamanetwork.com/journals/jama/article-abstract/256870
New article
Most acute cases can be successfully managed with medical, surgical, and/or endoscopic treatment with full recovery.
https://www.ncbi.nlm.nih.gov/books/NBK539698/
So it early treated outcome is good !
As i understand
3. Gallstones treatment prevent gallstone ileus
As it seems logic !
Thank you very much
The question about gallstones - in all literature it is said that it should be treated if it cause symptoms !
1. The question - should bile duct gallstones treated if they dont cause symptoms - as they have potential to obstruction of XXXXXXX duct, or it depends of other factors
As in all literature it is said that only symptomatic gallstones should be treated - ( as they cause symptoms in other place like bile duct )
2. As i understand - if dille duct obstruction is treated early the outcome is good -
There was one statement in old article
Man ordinarily tolerates mechanical obstruction of the common bile duct fairly well. Death from obstructive jaundice in the first few weeks of its course is quite rare and is only occasionally observed
https://jamanetwork.com/journals/jama/article-abstract/256870
New article
Most acute cases can be successfully managed with medical, surgical, and/or endoscopic treatment with full recovery.
https://www.ncbi.nlm.nih.gov/books/NBK539698/
So it early treated outcome is good !
As i understand
3. Gallstones treatment prevent gallstone ileus
As it seems logic !
Thank you very much
Brief Answer:
As detailed
Detailed Answer:
Hi.
Good to know fresh queries:
1> Bile duct stones will cause symptoms and complications hence should be treated asap.
2> Yes, timely treatment saves from complications. Pancreatitis causes more severe signs and symptom.
3> Gallstone ileus is caused by large gallstones that usually pass through fistula between gallbladder and intestine. Rare complication.
I hope these answer your queries. Feel free to ask for further relevant queries.
Dr T Chandrakant.
As detailed
Detailed Answer:
Hi.
Good to know fresh queries:
1> Bile duct stones will cause symptoms and complications hence should be treated asap.
2> Yes, timely treatment saves from complications. Pancreatitis causes more severe signs and symptom.
3> Gallstone ileus is caused by large gallstones that usually pass through fistula between gallbladder and intestine. Rare complication.
I hope these answer your queries. Feel free to ask for further relevant queries.
Dr T Chandrakant.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much for your help !
Questions by order
1. . Gallstones treatment prevent gallstone ileus ?
2. There was study about Early Postoperative Small Bowel Obstruction
and risk for later - Adhesive Small Bowel Obstruction
I understand mathematics - you can not compare two groups that is not equally numbers
There was
- 42 patients (4.2 %) developed EPSBO (early
postoperative small bowel obstruction )
- 85 (8.5 %) patients developed POI postoperative ileus
Then this study compare two groups those wit no such symptoms after surgery - that is not logic -
you can not compare tho groups with 2 times number difference and do conclusion
The occurrence of adhesive SBO was significantly higher in patients with EPSBO than in those without EPSBO (26.5 vs. 7.5 % at 5 years, P\0.001), but not in
patients with POI (13.4 vs. 7.8 % at 5 years, P = 0.158).
I think you agree with me - the question why such studies ar made - because they are wrong with conclusion !
3. There was one study that
prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery
https://sci-hub.se/10.1001/archsurg.135.2.208
There was said inguinal hernia repair in 196 - 5 (2.5%) cause small intestinal obstruction
As this is rather small group and in literature it is said that inguinal hernia rare cause small intestinal obstruction
How much % about ?
3. Early postoperative small-bowel obstruction could be managed non operative with
nasogastric decompression in most case
- if there is no serious desaese Early postoperative small-bowel obstruction - could be manager no operative is it so ? But if there is cancer and other severe disease re-operation could be required ? Logic
https://pubmed.ncbi.nlm.nih.gov/0000/
Thank you very much !
Questions by order
1. . Gallstones treatment prevent gallstone ileus ?
2. There was study about Early Postoperative Small Bowel Obstruction
and risk for later - Adhesive Small Bowel Obstruction
I understand mathematics - you can not compare two groups that is not equally numbers
There was
- 42 patients (4.2 %) developed EPSBO (early
postoperative small bowel obstruction )
- 85 (8.5 %) patients developed POI postoperative ileus
Then this study compare two groups those wit no such symptoms after surgery - that is not logic -
you can not compare tho groups with 2 times number difference and do conclusion
The occurrence of adhesive SBO was significantly higher in patients with EPSBO than in those without EPSBO (26.5 vs. 7.5 % at 5 years, P\0.001), but not in
patients with POI (13.4 vs. 7.8 % at 5 years, P = 0.158).
I think you agree with me - the question why such studies ar made - because they are wrong with conclusion !
3. There was one study that
prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery
https://sci-hub.se/10.1001/archsurg.135.2.208
There was said inguinal hernia repair in 196 - 5 (2.5%) cause small intestinal obstruction
As this is rather small group and in literature it is said that inguinal hernia rare cause small intestinal obstruction
How much % about ?
3. Early postoperative small-bowel obstruction could be managed non operative with
nasogastric decompression in most case
- if there is no serious desaese Early postoperative small-bowel obstruction - could be manager no operative is it so ? But if there is cancer and other severe disease re-operation could be required ? Logic
https://pubmed.ncbi.nlm.nih.gov/0000/
Thank you very much !
Brief Answer:
As detailed
Detailed Answer:
Hi.
1 > Gallstones if large enough alone can cause ileus - as already discussed.
2 > Obstruction and ileus are different things. Obstruction - as the name suggests. Ileus means no movement in bowels.
Larger is the group, better are the results. Small number of patients does not lead to conclusion.
As discussed already, there are multiple factors that lead to sequelae and complications and all such factors need to be included in the studies to be more fruitful.
https://sci-hub.se/10.1001/archsurg.135.2.208 : true. But can not say about percentage Open cases have least complications.
4 > True. Conservative management usually is sufficient along with maintenance of Electrolytes, better nutrition and so on. " wait if in doubt" is the adage.
Reoperation depends upon the cause irrespective of the original disease. Well prepared cases cause leasts possible complications.
I hope this answers all your queries.
Dr T Chandrakant.
As detailed
Detailed Answer:
Hi.
1 > Gallstones if large enough alone can cause ileus - as already discussed.
2 > Obstruction and ileus are different things. Obstruction - as the name suggests. Ileus means no movement in bowels.
Larger is the group, better are the results. Small number of patients does not lead to conclusion.
As discussed already, there are multiple factors that lead to sequelae and complications and all such factors need to be included in the studies to be more fruitful.
https://sci-hub.se/10.1001/archsurg.135.2.208 : true. But can not say about percentage Open cases have least complications.
4 > True. Conservative management usually is sufficient along with maintenance of Electrolytes, better nutrition and so on. " wait if in doubt" is the adage.
Reoperation depends upon the cause irrespective of the original disease. Well prepared cases cause leasts possible complications.
I hope this answers all your queries.
Dr T Chandrakant.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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