Non-therapeutic Management of Adhesive Small Bowel Obstruction: A Descriptive Map of Practice Patterns among General Surgeons in Saudi ArabiaCorrespondence Address :
Dr. Nasser Alzerwi,
Assistant Professor, Department of Surgery, College of Medicine, Majmaah University,
Ministry of Education, Al-Majmaah-11952, P. O. Box 66, Riyadh Region, Kingdom of
Saudi Arabia, Majmaah, Saudi Arabia.
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 crosssectional 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 Nonoperative 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.
Bowel adhesions, Questionnaire method, Survey
Date of Submission: Jun 28, 2020
Date of Peer Review: Jul 13, 2020
Date of Acceptance: Jul 25, 2020
Date of Publishing: Oct 01, 2020
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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• Plagiarism X-checker: Jun 29, 2020
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• iThenticate Software: Sep 15, 2020 (11%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
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- Popline (reproductive health literature)