Associated Factors for Adhesions Post Surgery: A Case Control Study

Abstract

BACKGROUND: Managing patients with adhesive small bowel obstruction (ASBO) requiring surgery is challenging, particularly in performing adhesiolysis safely while minimizing iatrogenic complications. Identifying at-risk patients is important, as it may facilitate earlier diagnosis and strengthen prophylactic measures. We conducted this study to report factors associated with ASBO. METHODS: A case-control study was conducted in the general surgery "B" department of Rabta Hospital, including patients operated on for ASBO between 2004 and 2020. Patients were asked to report ASBO occurrence following index surgery. Logistic regression analysis was used to determine associated factors. RESULTS: Two hundred patients were included, with 100 patients in each group. Radiological ischemic features were observed in 14.5% of cases. Surgery was performed in 35 patients, with laparoscopy attempted in 8.6% but converted in two cases. Postoperative complications occurred in 31.4% (n = 11), with two deaths (5.7%). Logistic regression revealed three independent factors associated with ASBO: male sex (adjusted OR = 7.489, 95% CI: 2.726-20.578; p < 0.0001), diabetes (adjusted OR = 15.465, 95% CI: 3.698-64.683; p = 0.0002), and Pfannenstiel incision (adjusted OR = 5.704, 95% CI: 1.456-22.351; p = 0.0125). CONCLUSION: This study highlights male sex, diabetes, and Pfannenstiel incision as associated factors for ASBO. Recognizing these risks may improve postoperative management and outcomes. Larger prospective multicenter studies are needed to validate these findings.