Effect of omentum removal on the risk for postoperative adhesive small bowel obstruction recurrence: A case-control study

Background: Surgical treatment for adhesive small bowel obstructions (ASBOs) is the only way to release the obstructive structure; however, opening the peritoneal cavity may cause new adhesions, possibly leading to recurrent episodes of ASBO. The risk factors for recurrent ASBO, after surgical treatment, are not fully understood. Methods: The hospital records of 113 patients undergoing surgery for ASBO at Shirakawa Kousei (Japan) General Hospital, between 2002 and 2013, were studied. We compared the pre- and postoperative factors, intraoperative findings, and surgical histories of 18 patients with and 95 patients without recurrent ASBO. The risk factors for ASBO recurrence, after surgery, were determined using Cox-proportional hazard ratios. Results: The 5-year cumulative rate of overall recurrence was 20.8%. Among the 18 patients of recurrence, 11 (61.1%) were readmitted within 1 year of surgical treatment. Multivariate analysis revealed that a history of omentectomy was an independent risk factor for recurrence (hazard ratio, 2.98; p=0.027). After omentectomy, the rate of adhesions to the peritoneum was significantly higher (with omentectomy, 54.5%; without omentectomy, 21.3%; p<0.001), and the risk of adhesion or matted adhesion was increased (with omentectomy, 87.9%; without omentectomy, 53.8%; p<0.001), compared with patients not undergoing omentectomy. Conclusion: Omentectomy significantly increases the likelihood of ASBO recurrence. Therefore, patients undergoing omentectomy may be candidates for prophylactic anti-adhesion agents, particularly when there is a risk of matted abdominal wall adhesions.