Promising results of a new treatment in patients with bowel obstruction in colorectal surgery

M Fahim; L M Dijksman; C S van Kessel; D P J Smeeing; A Braaksma; W J M Derksen; A B Smits

doi:10.1016/j.ejso.2019.10.011

Promising results of a new treatment in patients with bowel obstruction in colorectal surgery

Eur J Surg Oncol. 2020 Mar;46(3):415-419. doi: 10.1016/j.ejso.2019.10.011. Epub 2019 Oct 16.

Authors

M Fahim¹, L M Dijksman², C S van Kessel³, D P J Smeeing³, A Braaksma⁴, W J M Derksen³, A B Smits³

Affiliations

¹ Department of Surgery, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, the Netherlands; Department of Value-Based Healthcare, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, the Netherlands. Electronic address: m.fahim@antoniusziekenhuis.nl.
² Department of Value-Based Healthcare, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, the Netherlands.
³ Department of Surgery, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, the Netherlands.
⁴ Department of Nutrition and Health, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, the Netherlands.

PMID: 31676200
DOI: 10.1016/j.ejso.2019.10.011

Abstract

Introduction: Bowel obstruction increases risk of emergency surgery and leads to suboptimal physical and nutritional condition. Preventing emergency surgery and prehabilitation might improve outcomes. This pilot study aimed to examine the effect of a multimodal obstruction protocol for bowel obstruction patients on the risk of emergency surgery and postoperative morbidity and mortality.

Materials and methods: All bowel obstruction patients treated according to the obstruction protocol in the period 2013-2017 were included in this uncontrolled observational cohort study. Benign and malignant causes of bowel obstruction were included. The protocol consisted of: 1. specific dietary adjustments to reduce prestenotic dilatation, 2. oral laxatives and 3. prehabilitation. Emergency surgery and postoperative morbidity and mortality rates were compared to known rates from the literature.

Results: Sixty-one patients were included: 44 (72%) were treated for colorectal cancer and 17 (28%) for Crohn's disease or diverticulitis. Four patients (7%) underwent emergency surgery. Primary anastomosis was constructed in 49 out of 57 elective patients (86%). Severe complications (Clavien-Dindo ≥ III) occurred in four patients (7%). No bowel perforation, anastomotic leakages or 30-day mortality was observed. These rates were much lower than rates reported in the literature after surgery for colorectal cancer (3% bowel perforation, 8% anastomotic leakage, 4% 30-day mortality, 15% severe complications) and benign disease (30-day mortality 17%, severe complications 7%).

Conclusion: Using the obstruction protocol in patients with bowel obstruction reduced emergency surgery and postoperative morbidity and mortality in this pilot study. This protocol seems to be a viable and efficient alternative to emergency surgery.

Keywords: Bowel obstruction; Emergency surgery; Nutrition; Physical exercise; Postoperative outcomes; Prehabilitation.

Publication types

Observational Study

MeSH terms

Aged
Colorectal Neoplasms / surgery*
Digestive System Surgical Procedures / adverse effects
Elective Surgical Procedures / adverse effects
Exercise Therapy / methods*
Female
Follow-Up Studies
Humans
Incidence
Intestinal Obstruction / epidemiology
Intestinal Obstruction / etiology
Intestinal Obstruction / therapy*
Male
Middle Aged
Netherlands / epidemiology
Nutritional Support / methods*
Pilot Projects
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / therapy*
Retrospective Studies
Treatment Outcome