Abstract
Background
In majority of patients, early postoperative small bowel obstruction (EPSBO) resolves with nasogastric decompression and bowel rest alone, while in some patients, symptoms persist without urgent indications for surgery. The purpose of this study was the evaluation of home parenteral nutrition (HPN) instead of elective surgery as an initial approach to persistent EPSBO.
Methods
Patients developing EPSBO prescribed HPN without reoperation within 6 weeks after index intestinal surgery were identified from an institutional HPN registry and retrospectively compared with patients undergoing reoperation for EPSBO within the same time period.
Results
Thirty-four patients for the HPN group and 27 patients in elective reoperative (REOP) group met the inclusion criteria. In the HPN group, mean interval between surgery and PN initiation was 11 days. HPN duration ranged from 17 to 244 days with a median of 60 days. Thirty-one patients (91%) successfully recovered bowel function and resumed enteral nutrition without reoperation, while 3 patients required reoperation > 6 weeks after index surgery due to HPN failure. In the REOP group, mean interval between index surgery and reoperation was 17 days. At reoperation, 12 patients required bowel resection, 5 having incidental enterotomies, and 3 required new stoma creation. Postoperatively, 2 patients developed enterocutaneous fistulas, 1 experienced an anastomotic leak, and another had fascial dehiscence.
Conclusion
HPN is a safe alternative to elective surgery in clinically stable patients with persistent EPSBO. This approach avoids hazardous reoperation during the recovery phase when adhesions are at their worst.
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Burneikis: Study design, data acquisition, analysis, and drafting of the manuscript.
Stocchi: Study design, data interpretation, and drafting of the manuscript.
Steiger: Data interpretation and manuscript revision.
Jezerski: Data acquisition and manuscript revision.
Shawki: Study design, data interpretation, and manuscript revision.
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Burneikis, D., Stocchi, L., Steiger, E. et al. Parenteral Nutrition Instead of Early Reoperation in the Management of Early Postoperative Small Bowel Obstruction. J Gastrointest Surg 24, 109–114 (2020). https://doi.org/10.1007/s11605-019-04347-1
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DOI: https://doi.org/10.1007/s11605-019-04347-1