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Results

Results. Postoperative Outcomes and Follow-up of Patients. Median duration of in-hospital stay: 10 days ( range, 2–69 days ). M edian follow-up : 41 months P ostoperative complications: 39 patients sustained 40 post-op complications 23 medical complications:

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Results

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  1. Results

  2. Postoperative Outcomes and Follow-up of Patients • Median duration of in-hospital stay: 10 days (range, 2–69 days). • Median follow-up : 41 months • Postoperative complications: 39 patients sustained 40 post-op complications • 23 medical complications: • 19 cardiac or pulmonary, 2 urinary, 1 diabetic complications, and 1 DVT • 17 surgical complications: • 12 wound sepsis, 5 intraperitoneal complications.

  3. Deaths • Deaths: 8 (median age : 86 years; range: 76–98 years) • 7 cardiac or pulmonary complications and 1 postoperative intestinal necrosis. • Statistically signifant more complications (P 0.001) than the 278 alive patients who sustained 31 complications • Long-term follow-up deaths: 19 of the remaining 278 patients (median age, 78 years; range, 38–89 years) • None with recurrent adhesive postoperative small bowel obstruction. • Previously sustained 6 postoperative complications • 2 surgical: 1 wound infection, persisting ileus • 4 medical: 3 pulmonary and 1 diabetic complication • Postoperative period and long-term follow-up deaths: • The 27 patients who died had significantly more postoperative complications (n 14; 52%) than the 259 patients who were still alive (n 26; 10%) (P 0.0001).

  4. Reccurences

  5. Treatments and Outcomes of Patients WithIndependent Risk Factors of Recurrence • Forty-five patients (16%) underwent an intestinal resection. • Thirty-seven were mandatory because of necrosis in 27 patients with bands and 10 patients with adhesions or matted adhesions. • 8 intestinal resections were performed in patients with reversible ischemia or serosal defect or accidental enterotomy, corresponding to 6 patients with bands and 2 patients with adhesions or matted adhesions. • Intestinal resection was not judged necessary for 241 patients.

  6. Significant Risk Factors • Age <40 Years (n 76) • Out of 76 patients, 14 recurred. Nine patients (12%) were resected with no recurrence (0%), no complication and no deathw. • Sixty-seven patients (88%) were not resected and 14 recurred (21%) with 2 complications and no death. • Adhesions or Matted Adhesions • In this group of 106 patients, 21 (20%) recurred. • 12 patients (11%) were resected and 1 (10%) recurred. • 94 patients (89%) were not resected and 20 (21%) recurred with 3 complications and no deaths. \

  7. Postoperative Surgical Complications (n 17) • Out of the17 patients, 4 (23.5%) recurred. • Four patients (23.5%) were resected with no recurrences (0%). • Thirteen patients (76.5%) were not resected and 4 recurred(31%) with 1 death. • Reversible ischemia due to bands led to 3 postoperative necroses (2 reoperations) and 1 death.

  8. Discussion

  9. DISCUSSION • The study estimated the overall and surgical cumulative incidence (15.9% and 5.8%.) of the risk factors of recurrence following an operated adhesive postoperative SBO. • The study also gave significant risk factors in recurrence: • Age < 40 years • Adhesions or matted adhesions • Postoperative surgical complications • The death rate of 3 % and complication rate 14 % were consistent with other studies.

  10. DISCUSSION • Operated adhesive postoperative SBO may be classified as a high-risk recurrence procedure. • overall and surgical recurrence rates comparable with other high risk surgical procedures of adhesive postoperative SBO i.e. colorectal surgery.

  11. DISCUSSION • Age < 40 as a risk factor for reccurrence • Pathophysiologicexplanation of the role of young age in the onset of recurrences are rare. • No study dedicated to the potential specificity of the peritoneal healing in the young adult. • No study in the role of the decreased of gastrointestinal tract mobility with

  12. DISCUSSION • Adhesions or matted adhesions: • The magnitude of the surgical peritoneal trauma, due to the frequently difficult division of this type of obstructive structures, produces attendant inflammatory reaction. • The resulting decrease of the intraperitonealfibrinolyticactivity may favor adhesion formation and recurrence.

  13. DISCUSSION • Postoperative surgical complications • This factor may be linked to increased number of adhesions resulting from postoperative surgical complications. • The distribution of recurrences after the postoperative surgical complications (4 patients recurred after conservative treatment vs. none after resection) may also lead to more resections especially among “debatable” resection patients.

  14. DISCUSSION • Number of previous operations • Does not appear as a risk factor of recurrence in contrast with the results of other univariateand multivariate analyses. • Difference may be due to the higher rate of previous operations in thestudy • (22% sustained 3 or more previous operations compared with 6% and 11%, respectively, in the Fevang et al and Miller et al series), • The study does not highlight any specific category of previous operations entailing a higher rate of recurrence.

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