NON-OPERATIVE MANAGEMENT VS. EARLY SURGERY FOR ADHESIVE SMALL BOWEL OBSTRUCTION

Abstract

Background: Adhesive small bowel obstruction (ASBO) is a frequent surgical emergency. While non‑operative management (NOM) often succeeds, prolonged obstruction may increase morbidity. Early operative management (EOM) can relieve obstruction promptly but carries surgical risks. Objective: To compare clinical outcomes between NOM and EOM in patients admitted with ASBO. Methods: We performed a retrospective cohort study of adults (≥18 years) treated for ASBO  between January 2018 and December 2022. Patients were grouped by initial treatment strategy: NOM (bowel rest, nasogastric decompression, IV fluids; n=160) versus EOM (surgery within 24 hours of admission; n=80). Primary outcomes were resolution rate, length of hospital stay (LOS), and overall complication rate. Secondary outcomes included time to oral intake, 30‑day mortality, and readmission for recurrent obstruction. Continuous variables were compared with t‑tests; categorical variables with Chi‑square; multivariate logistic regression adjusted for age, comorbidity, and prior surgeries assessed predictors of complications. Results: Baseline characteristics (mean age  sixty-two ± 14 years; 54% female; mean prior laparotomies 2.1 ± 1.0) were similar between groups. NOM succeeded in 128/160 (80%) patients; 32 (20%) required delayed surgery after a median of 72 hours. Mean LOS was shorter in EOM (7.2 ± 2.5 days) versus NOM (9.1 ± 3.4 days; p < 0.001). Overall complications occurred in 18.8% of NOM and 27.5% of EOM patients (p = 0.12). Time to oral intake was faster after EOM (3.8 ± 1.2 days vs. 5.1 ± 1.6 days; p < 0.001). Thirty‑day mortality did not differ (NOM 1.9% vs. EOM 2.5%; p = 0.76). Re‑admission for recurrent ASBO within six months was higher after NOM (12.5% vs. 6.3%; p = 0.08). Conclusion: Early operative management of ASBO is associated with shorter hospital stays and quicker return to diet, with comparable morbidity and mortality to non‑operative management. Patient‑specific factors must guide the timing of surgery to optimize outcomes.