Comparative Outcomes of Early Surgical Intervention Versus Nonoperative Management in Adhesive Small Bowel...

Adhesive small bowel obstruction (ASBO) is a common cause of intestinal obstruction, often managed either through nonoperative strategies or early surgical intervention.

To compare the outcomes of nonoperative management versus early surgery in patients presenting with ASBO.

This comparative observational study was conducted at Shahida Islam Teaching Hospital, Lodhran, from February 2024 to August 2024. A total of 201 patients with clinically and radiologically confirmed ASBO were included through non-probability consecutive sampling. Patients were divided into two groups: Group A received nonoperative management, while Group B underwent early surgical intervention within 24 hours of admission.

Among 201 patients, 120 (59.7%) were managed nonoperatively and 81 (40.3%) underwent early surgery. Clinical resolution without surgery was achieved in 104/120 (86.7%) patients in the nonoperative group. Complications occurred in 6/120 (5.0%) patients in the nonoperative group versus 23/81 (28.4%) in the surgical group (P = 0.02). The mean hospital stay was significantly shorter in the nonoperative group (4.6 ± 1.8 days) compared to the early surgery group (8.1 ± 2.5 days, P < 0.001). However, recurrence within six months was significantly higher in the nonoperative group (26/120, 21.7%) compared to the early surgery group (7/81, 8.6%) (P = 0.01).

Nonoperative management remains effective and safe for uncomplicated ASBO, offering shorter hospitalization and fewer immediate complications. Although early surgical intervention was associated with a higher complication rate, this finding likely reflects the inclusion of patients with more advanced disease at presentation rather than surgical risk alone. Early operative management remains essential for complicated or non-resolving cases to prevent ischemic injury and recurrence.