World Journal of Surgery

, Volume 38, Issue 11, pp 3007–3014 | Cite as

Early Postoperative Small Bowel Obstruction is an Independent Risk Factor for Subsequent Adhesive Small Bowel Obstruction in Patients Undergoing Open Colectomy

  • Soo Young Lee
  • Kyu Joo Park
  • Seung-Bum Ryoo
  • Heung-Kwon Oh
  • Eun Kyung Choe
  • Seung Chul HeoEmail author
Original Scientific Report



This prospective study was performed to investigate whether postoperative ileus (POI) or early postoperative small bowel obstruction (EPSBO) affects the development of adhesive small bowel obstruction (SBO) in patients undergoing colectomy.


We prospectively enrolled 1,002 patients who underwent open colectomy by a single surgeon. POI was defined as the absence of bowel function for more than 5 days or as a delay in oral intake beyond 7 days postoperatively. EPSBO was defined as the clinical and radiologic identification of SBO after resuming oral intake between postoperative days 7 and 30. Adhesive SBO was defined as SBO developing after 30 days because of intraperitoneal adhesion. The associations between POI, EPSBO, patient- and surgery-related variables, and the development of adhesive SBO were analyzed.


A total of 85 (8.5 %) patients developed POI, and 42 patients (4.2 %) developed EPSBO, with seven patients experiencing both POI and EPSBO. During the follow-up period (median 51 months), 70 patients (7.0 %) developed adhesive SBO, six (8.6 %) of whom needed laparotomy. The occurrence of adhesive SBO was significantly higher in patients with EPSBO than in those without EPSBO (26.5 vs. 7.5 % at 5 years, P < 0.001), but not in patients with POI (13.4 vs. 7.8 % at 5 years, P = 0.158). Multivariable analysis showed colostomy (hazard ratio [HR] 2.530, P = 0.006) and EPSBO (HR 4.063, P < 0.001) as independent risk factors for adhesive SBO.


The development of adhesive SBO after colectomy is more frequent in patients with EPSBO and colostomy; however, POI does not increase the risk of adhesive SBO.


Small Bowel Obstruction Ileal Pouch Subtotal Colectomy Open Colectomy Pseudomyxoma Peritonei 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflicts of interest

The authors received no commercial support for this study. The authors declare no conflicts of interest.


  1. 1.
    Weibel MA, Majno G (1973) Peritoneal adhesions and their relation to abdominal surgery. a postmortem study. Am J Surg 126:345–353PubMedCrossRefGoogle Scholar
  2. 2.
    Parker MC, Wilson MS, Menzies D et al (2004) Colorectal surgery: the risk and burden of adhesion-related complications. Colorectal Dis 6:506–511PubMedCrossRefGoogle Scholar
  3. 3.
    Parker MC, Wilson MS, Menzies D et al (2005) The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis 7:551–558PubMedCrossRefGoogle Scholar
  4. 4.
    Schnuriger B, Barmparas G, Branco BC et al (2011) Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg 201:111–121PubMedCrossRefGoogle Scholar
  5. 5.
    Ellis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480PubMedCrossRefGoogle Scholar
  6. 6.
    Artinyan A, Nunoo-Mensah JW, Balasubramaniam S et al (2008) Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World J Surg 32:1495–1500. doi: 10.1007/s00268-008-9491-2 PubMedCrossRefGoogle Scholar
  7. 7.
    Kronberg U, Kiran RP, Soliman MS et al (2011) A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg 253:78–81PubMedCrossRefGoogle Scholar
  8. 8.
    Kehlet H, Holte K (2001) Review of postoperative ileus. Am J Surg 182:3s–10sPubMedCrossRefGoogle Scholar
  9. 9.
    Pickleman J, Lee RM (1989) The management of patients with suspected early postoperative small bowel obstruction. Ann Surg 210:216–219PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Nissen LM, Tett SE, Cramond T et al (2001) Opioid analgesic prescribing and use: an audit of analgesic prescribing by general practitioners and The Multidisciplinary Pain Centre at Royal Brisbane Hospital. Br J Clin Pharmacol 52:693–698PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Baig MK, Wexner SD (2004) Postoperative ileus: a review. Dis Colon Rectum 47:516–526PubMedCrossRefGoogle Scholar
  12. 12.
    Luckey A, Livingston E, Tache Y (2003) Mechanisms and treatment of postoperative ileus. Arch Surg 138:206–214PubMedCrossRefGoogle Scholar
  13. 13.
    Snoek SA, Dhawan S, van Bree SH et al (2012) Mast cells trigger epithelial barrier dysfunction, bacterial translocation and postoperative ileus in a mouse model. Neurogastroenterol Motil 24(172–184):e191Google Scholar
  14. 14.
    Sajja SB, Schein M (2004) Early postoperative small bowel obstruction. Br J Surg 91:683–691PubMedCrossRefGoogle Scholar
  15. 15.
    Shin JY, Hong KH (2008) Risk factors for early postoperative small-bowel obstruction after colectomy in colorectal cancer. World J Surg 32:2287–2292. doi: 10.1007/s00268-008-9652-3 PubMedCrossRefGoogle Scholar
  16. 16.
    Nakajima J, Sasaki A, Otsuka K et al (2010) Risk factors for early postoperative small bowel obstruction after colectomy for colorectal cancer. World J Surg 34:1086–1090. doi: 10.1007/s00268-010-0462-z PubMedCrossRefGoogle Scholar
  17. 17.
    Shin JY (2011) Risk factors of early postoperative small bowel obstruction following a proctectomy for rectal cancer. J Korean Soc Coloproctol 27:315–321PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Schein M, Sajja SB, Yenumula PR (2002) Early postoperative intestinal obstruction. Curr Surg 59:289–295PubMedCrossRefGoogle Scholar
  19. 19.
    MacLean AR, Cohen Z, MacRae HM et al (2002) Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 235:200–206PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Marcello PW, Roberts PL, Schoetz DJ Jr et al (1993) Obstruction after ileal pouch-anal anastomosis: a preventable complication? Dis Colon Rectum 36:1105–1111PubMedCrossRefGoogle Scholar
  21. 21.
    Holmdahl L (1997) The role of fibrinolysis in adhesion formation. Eur J Surg Suppl 577:24–31PubMedGoogle Scholar
  22. 22.
    Arung W, Meurisse M, Detry O (2011) Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 17:4545–4553PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Soo Young Lee
    • 1
  • Kyu Joo Park
    • 2
  • Seung-Bum Ryoo
    • 2
  • Heung-Kwon Oh
    • 1
  • Eun Kyung Choe
    • 3
  • Seung Chul Heo
    • 4
    Email author
  1. 1.Department of SurgerySeoul National University Bundang HospitalSeongnamKorea
  2. 2.Department of SurgerySeoul National University HospitalSeoulKorea
  3. 3.Department of SurgerySeoul National University Hospital Healthcare System Gangnam CenterSeoulKorea
  4. 4.Department of SurgerySeoul National University College of Medicine, Seoul Metropolitan Government Boramae HospitalSeoulKorea

Personalised recommendations