What is the purpose of small bowel resection for small bowel obstruction (SBO)?

From the Guidelines

The primary purpose of small bowel resection for small bowel obstruction (SBO) is to remove the blocked segment of intestine that cannot be resolved through conservative management, thereby preventing complications such as bowel strangulation, ischemia, perforation, and peritonitis. This surgical procedure is typically performed when there is evidence of bowel compromise or complete mechanical obstruction that fails to respond to non-operative measures. During the procedure, the surgeon removes the affected portion of small intestine and reconnects the healthy ends (anastomosis) [ 1 ]. The most recent guidelines recommend open or laparoscopic small bowel segmental resection and primary anastomosis as the treatment of choice for SBO [ 1 ].

Key Considerations

• The decision to perform small bowel resection is based on the presence of complications such as bowel strangulation, ischemia, or perforation [ 1 ].
• The surgical approach may involve open or laparoscopic techniques, depending on the patient's condition and the surgeon's expertise [ 1 ].
• Postoperative management includes nasogastric tube decompression, gradual advancement of diet, pain management, and early mobilization to prevent complications [ 1 ].

Outcomes and Risks

• The mortality risk of emergency small bowel resection ranges from 5-15%, with higher rates in elderly patients or those with significant comorbidities [ 1 ].
• Appropriate patient selection and timing are crucial for optimal outcomes, and the decision to perform surgery should be made on a case-by-case basis [ 1 ].

Recent Guidelines and Recommendations

• The most recent guidelines recommend antibiotic therapy for 4 days in immunocompetent patients and up to 7 days in immunocompromised or critically ill patients, depending on the clinical conditions and inflammation indices [ 1 ].
• Patients who have ongoing signs of infection or systemic illness beyond 7 days of antibiotic treatment warrant a diagnostic investigation [ 1 ].

From the Research

Purpose of Small Bowel Resection for SBO

The purpose of small bowel resection for small bowel obstruction (SBO) is to remove the obstructed portion of the intestine and restore normal bowel function. This procedure is often necessary when the obstruction is caused by a physical blockage, such as a tumor, adhesion, or hernia, and cannot be resolved with non-surgical methods.

Indications for Small Bowel Resection

• Strangulation or ischemia of the bowel, which can lead to tissue death and perforation 2, 3, 4
• Failure of non-operative treatment, such as nasogastric tube decompression and fluid resuscitation 5, 6
• Presence of a physical blockage, such as a tumor or adhesion, that cannot be resolved with non-surgical methods 2, 3
• Signs of peritonitis or sepsis, which require prompt surgical intervention 2, 3, 6

Benefits of Laparoscopic Approach

• Reduced postoperative complications and morbidity compared to open bowel resection 2
• Shorter length of stay and equivalent operative time compared to open bowel resection 2
• Less postoperative wound and respiratory infections compared to open bowel resection 2
• Improved outcomes and reduced risk of adverse events with laparoscopic adhesiolysis 3

Patient Selection and Evaluation

• Adequate patient selection through physical examination and computed tomography is crucial to determine the need for surgical intervention 4
• Patients with suspected strangulation or bowel ischemia require prompt surgical evaluation and admission 6
• Patients with a history of abdominopelvic surgery and signs of obstruction should be suspected to have adhesive small bowel obstruction until proven otherwise 3