Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

Area of Science:

• General Surgery
• Surgical Practice

Background:

• Historical surgical dogma advises against nonoperative management of small bowel obstruction (SBO).
• Advances in imaging, like computed tomography (CT) scans, allow for non-ischemic SBO assessment, enabling nonoperative management trials.
• Current surgical practices for adhesive SBO management are not well-documented.

Purpose of the Study:

• To investigate current general surgeon management strategies for patients with small bowel obstruction (SBO).
• To assess consistency in the perceived safe duration for nonoperative management of SBO.
• To understand surgeon decision-making regarding SBO treatment.

Main Methods:

• A case vignette of a complete SBO without ischemia was used.
• A purposive sample of 15 general surgeons in Washington State were interviewed.
• Content analysis was performed on interview data to identify practice patterns and attitudes.

Main Results:

• Surgical management of SBO varied significantly among interviewed surgeons.
• The acceptable nonoperative management duration ranged from 1 to 7 days.
• Surgeons reported a lack of evidence guiding SBO management and acknowledged practice variation.

Conclusions:

• A shift away from immediate surgery for adhesive SBO is occurring.
• There is considerable variation and a lack of consensus on the optimal duration for nonoperative SBO management.
• Findings highlight the need for further research, including randomized trials, to establish evidence-based guidelines.