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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.
The British Journal of Surgery
|December 16, 2015
Summary
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.
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