Effect of omentum removal on the risk for postoperative adhesive small bowel obstruction recurrence: a case-control...

Surgical treatment for adhesive small bowel obstructions (ASBOs) is the only way to release the obstructive structure; however, opening the peritoneal cavity may cause new adhesions, possibly leading to recurrent episodes of ASBO. The risk factors for recurrent ASBO, after surgical treatment, are not fully understood.

The hospital records of 113 patients undergoing surgery for ASBO at Shirakawa Kousei (Japan) General Hospital, between 2002 and 2013, were studied. We compared the pre- and postoperative factors, intraoperative findings, and surgical histories of 18 patients with and 95 patients without recurrent ASBO. The risk factors for ASBO recurrence, after surgery, were determined using Cox-proportional hazard ratios.

The 5-year cumulative rate of overall recurrence was 20.8%. Among the 18 patients of recurrence, 11 (61.1%) were readmitted within 1 year of surgical treatment. Multivariate analysis revealed that a history of omentectomy was an independent risk factor for recurrence (hazard ratio, 2.98; p = 0.027). After omentectomy, the rate of adhesions to the peritoneum was significantly higher (with omentectomy, 54.5%; without omentectomy, 21.3%; p < 0.001), and the risk of adhesion or matted adhesion was increased (with omentectomy, 87.9%; without omentectomy, 53.8%; p < 0.001), compared with patients not undergoing omentectomy.

Omentectomy significantly increases the likelihood of ASBO recurrence. Therefore, patients undergoing omentectomy may be candidates for prophylactic anti-adhesion agents, particularly when there is a risk of matted abdominal wall adhesions.