P4034 - Surgical vs Conservative Management of Patients With Adhesive Small Bowel Obstruction: An Updated Systematic Review and Meta-Analysis

Priya Kumari Maheshwari, MD¹, Dheeraj Kumar Maheshwari, MBBS², Tekchand Maheshwari, MBBS³
1University of Central Florida, HCA Healthcare GME, Pensacola, FL; 2Liaquat University of Medical and Health Science, Pensacola, FL; 3Isra University, Hyderabad, Sindh, Pakistan

Introduction: Adhesive small bowel obstruction (ASBO) is one of the most common reasons for hospitalization due to intestinal obstruction. While conservative management is typically the initial approach in clinically stable patients, it is associated with high recurrence rates. However, considerable variability exists in clinical practice. We conducted a systematic review and meta-analysis (SRMA) comparing surgical versus conservative management of ASBO, focusing on recurrence and complication outcomes.

Methods: The SRMA was conducted in accordance with PRISMA guidelines. Data on ASBO recurrence and complication rates were extracted from studies that met predefined inclusion criteria. Risk of bias was evaluated using the Cochrane Risk of Bias Tool (RoB 1) for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Odds ratios (ORs) with 95% confidence intervals (CI) was calculated using random-effect models, and heterogeneity was assessed using the I² statistic.

Results: A total of 10 comparative studies encompassing 46,212 patients were included in the analysis. Surgical management was associated with a significantly lower risk of recurrence compared to conservative management (OR: 0.52; 95% CI: 0.38–0.70; P < 0.0001), despite notable heterogeneity (I² = 85%) (Figure 1). While the incidence of overall complications appeared higher in the surgical group, this difference did not reach statistical significance (OR: 2.23; 95% CI: 0.92–5.40; P = 0.08), with moderate heterogeneity observed (I² = 65%) (Figure 2). These findings suggest that surgical intervention may be preferable in reducing long-term recurrence, without a definitive increase in short-term complication rates.

Discussion: ASBO is a frequent complication of prior abdominal surgery, resulting from fibrous intra-abdominal adhesions. These findings underscore an important clinical consideration: while surgery may offer superior recurrence prevention, it does not appear to significantly increase complication risk. Management strategies should therefore be individualized, balancing patient stability, surgical history, and institutional resources to optimize outcomes.


Figure: Figure 1: Forest Plot - Odds ratio (OR) of recurrence rate of adhesive small bowel obstruction comparing surgical management vs conservative management


Figure: Figure 2: Forest Plot - Odds ratio (OR) of overall complications of adhesive small bowel obstruction comparing surgical management vs conservative management

Disclosures:
Priya Kumari Maheshwari indicated no relevant financial relationships.
Dheeraj Kumar Maheshwari indicated no relevant financial relationships.
Tekchand Maheshwari indicated no relevant financial relationships.

Priya Kumari Maheshwari, MD¹, Dheeraj Kumar Maheshwari, MBBS², Tekchand Maheshwari, MBBS³. P4034 - Surgical vs Conservative Management of Patients With Adhesive Small Bowel Obstruction: An Updated Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.