Recurrence Following Operative vs. Non-Operative Management of Adhesive Small Bowel Obstruction in Children: A Multi-center Prospective Observational Study

Infographic · Apr 2025 · 1 min read

In brief

Multi-center study of 136 children with adhesive small bowel obstruction found 15% recurrence within one year, with no significant difference between operative and non-operative management after age adjustment. One-third of recurrent cases required urgent surgery at readmission, supporting non-operative management as equally effective in preventing recurrence.

Recurrent adhesive small bowel obstruction occurs in ~15% of pediatric patients within one year, regardless of initial management approach.
Non-operative management is as effective as surgery in preventing recurrent ASBO in children when adjusted for age.
One-third of children with recurrent ASBO require urgent or emergent surgery at readmission, independent of initial treatment strategy.
Initial non-operative management success rate for pediatric ASBO is approximately 64% based on multi-center prospective data.
Age is a significant confounding factor when comparing recurrence rates between operative and non-operative management groups.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage values.

Utsav M Patwardhan, Romeo C Ignacio, Kaci Pickett-Nairne, Katie W Russell, Justin Lee, Ben Padilla, Caroline Melhado, Lorraine I Kelley-Quon, David H Rothstein, Hariharan Thangarajah, Ana Ibarra-Meraz, Rabab M Barq, Kezlyn E Larsen, Kathryn L Fowler, Zebediah Hunteman, Maria Valencia-Bradd, Katrine Lofberg, Aaron Jensen, Samir Pandya, Shannon N Acker; Western Pediatric Surgery Research Consortium

Objective: Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to non-operative management (NOM).

Methods: We conducted a prospective observational study of children with ASBO admitted to nine hospitals from 10/2020 to 12/2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.

Results: Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, twenty patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs. 6.1%, P=0.04). However, after adjusting for age (HR 0.35, CI 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.

Conclusion: Although the rate of recurrent ASBO in children is nearly 15% within one year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.

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