Enhanced recovery programmes after surgery improve short-term outcomes following adhesive small bowel obstruction

Background: Surgery for adhesive small bowel obstruction (aSBO) has a high rate of complications and a recurrence rate of between 10 and 20% after one year of follow-up. A three-day trial of conservative management is usually proposed before surgical management. Enhanced recovery programs (ERP) have recently been proposed for use in emergency settings to improve short- and long-term outcomes, but have not yet been assessed for use in ASBO surgery. The objective was to assess the impact of ERP on postoperative morbidity and one-year recurrence of aSBO. Methods: This retrospective monocentric study included 325 patients undergoing surgery for aSBO in an emergency setting between 2014 and 2023. Postoperative morbidity was defined as any deviation from the normal postoperative course until hospital discharge. Recurrence during the one-year follow-up period was defined as any readmission for aSBO confirmed by CT scan. Results: Overall morbidity occurred in 109 patients (33.5%), and recurrence occurred in 42 patients (12.9%) during the one-year follow-up period. Enhanced Recovery Programs (ERP) significantly reduced the risk of postoperative complications after aSBO surgery (OR = 0.13; 95% CI: 0.02–0.81). Open surgery or conversion in open were associated with an increased risk of complication (respectively OR=3.23; 95%CI:1.52-6.83 and OR=3.03; 95%CI: 1.26-7.28). Conversely, ERP had no influence on postoperative recurrence. Completion of laparotomy was associated with an increased risk of recurrence (OR = 3.09, 95%CI: 1.88–14.59). Conclusion: Laparoscopy may be the most important item of the ERP after aSBO surgery as it reduces the risk of postoperative morbidity and one-year recurrence.