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Adhesive small bowel obstruction after laparotomy during infancy
F Fredriksson1, R H Christofferson1, H E Lilja1
1Department of Women's and Children's Health, Section of Paediatric Surgery, Uppsala University, SE-751 85, Uppsala, Sweden.
Insights
Infants undergoing laparotomy face a high risk of adhesive small bowel obstruction, with most cases occurring within two years. Risk factors include lengthy surgery, stoma formation, and postoperative complications.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- Intra-abdominal adhesions are a common complication following abdominal surgery.
- Adhesions can lead to serious conditions such as adhesive small bowel obstruction (ASBO), chronic abdominal pain, and female infertility.
- Long-term outcomes after infant laparotomy are not well-documented.
Purpose of the Study:
- To determine the incidence of long-term adhesive small bowel obstruction (ASBO) after infant laparotomy.
- To identify risk factors associated with ASBO and related morbidity in this population.
- To evaluate the long-term consequences of infant laparotomy, including chronic pain and infertility.
Main Methods:
- Retrospective cohort study of infants who underwent laparotomy between 1976 and 2011.
- Data collection through medical records review and patient questionnaires.
- Analysis of incidence, risk factors, and long-term morbidity, including ASBO, chronic pain, and infertility.
Main Results:
- A total of 898 patients were analyzed with a median follow-up of 14.7 years.
- The incidence of ASBO requiring relaparotomy was 12.6% (113 patients), with 69.9% occurring within 2 years of initial surgery.
- Highest ASBO incidence observed in patients with Hirschsprung's disease (29%), malrotation (29%), intestinal atresia (28%), and necrotizing enterocolitis (25%).
- Independent risk factors for ASBO included lengthy surgery (HR 1.25), stoma formation (HR 1.72), and postoperative complications (HR 1.81).
- Chronic abdominal pain was reported by 24.0% of patients, and 13.8% of women reported infertility.
Conclusions:
- The incidence of adhesive small bowel obstruction following laparotomy in infancy is notably high.
- Early identification of risk factors and potential complications is crucial for managing patients who underwent infant laparotomy.
- Long-term surveillance is warranted for infants undergoing laparotomy due to the significant risk of ASBO and associated morbidity.
Background:
Intra-abdominal adhesions can cause adhesive small bowel obstruction, chronic abdominal pain and female infertility. Reports on long-term outcomes following laparotomy during infancy are scarce. The aims of this study were to investigate the incidence of and risk factors for long-term adhesive small bowel obstruction and associated morbidity after laparotomy during infancy.
Methods:
Infants who underwent laparotomy between 1976 and 2011 were identified. Data were extracted from medical records and a questionnaire was sent to the patients.
Results:
Some 898 of 1185 eligible patients were included, with a median follow-up time of 14.7 (range 0.0-36.0) years. Median age at first laparotomy was 6 (range 1.0-365.0) days. There were 113 patients (12.6 per cent) with adhesive small bowel obstruction who underwent relaparotomy, 79 (69.9 per cent) occurring during the first 2 years after the initial laparotomy. The highest incidence of small bowel obstruction was found in patients with Hirschsprung's disease (19 of 65, 29 per cent), malrotation (13 of 45, 29 per cent), intestinal atresia (11 of 40, 28 per cent) and necrotizing enterocolitis (16 of 64, 25 per cent). Lengthy duration of surgery (hazard ratio (HR) 1.25, 95 per cent c.i. 1.07 to 1.45), stoma formation (HR 1.72, 1.15 to 2.56) and postoperative complications (HR 1.81, 1.12 to 2.92) were independent risk factors. Chronic abdominal pain was reported in 180 (24.0 per cent) of 750 patients, and 17 (13.8 per cent) of 123 women reported infertility.
Conclusion:
The incidence of adhesive small bowel obstruction after laparotomy in infants is high.
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