Non-therapeutic Management of Adhesive Small Bowel Obstruction: A Descriptive Map of Practice Patterns among General Surgeons in Saudi Arabia

Abstract

Introduction: Adhesive Small Bowel Obstruction (ASBO) is a common postoperative complication, and its management is challenging and controversial. Published guidelines for management are inconsistent and therefore, management practices vary based on institutions and individual surgeons. Aim: To evaluate variation of practice patterns among general surgeons and residents in investigation and non-therapeutic management of ASBO. Materials and Methods: This descriptive multi-centric cross-sectional study was done on 250 general surgery trainees and practitioners who were selected to be part of the study between January-February 2020 by simple random sampling. The participants were evaluated by questionnaire method which included standard of care, current practices and variability in non-therapeutic management of ASBO. Results: In total, 198 (79.2%) participants with mean (SD) age and duration of practice 36.5 (7.70) and 9.40 (7.26) years, responded, the majority (60%) of the respondents agreed on the use of routine abdominal Contrast-Enhanced Computed Tomography (CECT) for suspected ASBO. Resuscitation as per haemodynamics was preferred over positive fluid balance by 64.6%; nasogastric drainage was considered mandatory by 76.3% and the passage of flatus was considered the most important determinant of clinical resolution of the obstructive episode by 55.1% of respondents. Around a third of the respondents (36.4%) were of the opinion that resumption of oral intake should begin with sips of water and another 47.5% thought that 48 hours is the maximum waiting period for Non-operative Management (NOM). Conclusion: This study demonstrates that there is high variability between general surgeons in most aspects of ASBO non-therapeutic management. The findings underscore the need for developing national standard consensus-based guidelines to allow timely and effective management of this complex and potentially life-threatening condition.