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Clinical Outcomes of Non-Operative Versus Operative Treatment in Adhesive Small Bowel Obstruction: A Systematic
1Department of General Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
ANZ Journal of Surgery
|July 3, 2026
Summary
Operative management reduces adhesive small bowel obstruction (ASBO) recurrence but increases complications and costs. Elective surgery may benefit patients with recurring ASBO episodes.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Systematic Reviews
Background:
- Adhesive small bowel obstruction (ASBO) is a common complication after abdominal surgery, often leading to recurrent episodes despite conservative treatment.
- Adhesions, the primary cause of ASBO, persist even after successful non-operative management, highlighting the need to evaluate different treatment strategies.
- This systematic review and meta-analysis addresses the clinical outcomes of operative versus non-operative management for ASBO.
Purpose of the Study:
- To compare the efficacy of operative and non-operative management strategies for adhesive small bowel obstruction (ASBO).
- To evaluate differences in recurrence rates, mortality, complications, and length of hospital stay (LOS) between surgical and non-surgical approaches.
- To determine the optimal management strategy for ASBO, particularly for recurrent cases.
Main Methods:
- A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for relevant randomized and non-randomized studies (NRSs) published up to November 2025.
- Pooled results for recurrence, mortality, complications, and length of hospital stay (LOS) were analyzed.
- The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used to assess the risk of bias in included NRSs.
Main Results:
- Operative management significantly reduced ASBO recurrence across all study designs.
- No significant differences in overall mortality were observed, except for short-term mortality in clinical data NRSs.
- Operative treatment was linked to higher complication rates, longer LOS, and increased treatment costs compared to non-operative management.
Conclusions:
- While operative management effectively reduces ASBO recurrence, it is associated with increased complications, longer hospital stays, and higher costs.
- Non-operative management may be preferred for initial episodes due to lower morbidity and costs.
- Elective surgery presents a potential benefit for patients experiencing recurrent episodes of adhesive small bowel obstruction.
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