Non-operative management of small bowel obstruction in virgin abdomen: a systematic review.

The aim of this study was to systematically review the feasibility and safety of non-operative management of small bowel obstruction (SBO) in virgin abdomen. A systematic review was performed through December 2019. The primary outcome was the resolution of non-operative management of SBO in virgin abdomen. Secondary outcomes were the etiology of SBO and findings of exploratory laparotomy. Six studies were included in the analysis. Of the 442 patients, 2 with metastatic cancer received palliative care, and the management in 26 was not reported, so these patients were excluded. A total of 414 patients were ultimately analyzed, including 203 patients (49%) who were managed non-operatively and 211 (51%) who underwent surgical management. Of the 203 managed non-operatively, the condition of 194 (96%) was resolved without further intervention. The remaining 9 (5%) patients failed non-operative management and ultimately required surgery. Of the 211 patients who underwent surgical exploration, only 137 had their intraoperative findings reported. Adhesions (n = 67; 49%) were the main cause, followed by malignancy (n = 14; 10%) and others (n = 33; 24%). No cause was found in 23 patients (17%). In highly select cases of SBO with virgin abdomen, non-operative management can be attempted if patients are clinically stable and computed tomography does not demonstrate concerning features or obvious pathology. Further well-designed prospective studies will be required prior to the introduction of this concept in clinical practice, as current evidence remains heterogeneous.

Predictors of poor outcomes in children with tracheoesophageal fistula/oesophageal atresia: an Australian experience.

Objective: The aim of this study is to characterize long-term morbidities of oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF). Methods: Infants born with OA/TOF from 2000 to 2016 in Western Australia were included for analysis. Infants were categorized into high-risk and low-risk groups based on the presence of one or more perioperative risk factors [low birth weight, vertebraldefects, anal atresia, cardiac defects, TOF, renalanomalies, limb abnormalities (VACTERL), anastomotic leak, long gap OA, and failure to establish oral feeds within the first month] identified by a previous Canadian study. Frequency of morbidities in infants with perioperative risk factors was compared. Results: Of 102 patients, 88 (86%) had OA with distal TOF (type C). The most common morbidities in our cohort were anastomotic oesophageal strictures (AS) (n=53, 52%), tracheomalacia (n=48, 47%), gastroesophageal reflux disease (GORD) (n=42, 41%) and recurrent respiratory tract infections (n=40, 39%). Presence of GORD (30/59 vs 12/43, p=0.04) and median frequency of AS dilatations (8 vs 3, n=59, p=0.03) were greater in the high-risk group. This study further confirmed that inability to be fed orally within the first month was associated with high morbidities. Conclusions: Gastrointestinal and respiratory morbidities remain high in OA/TOF regardless of perioperative risk factors. Inability to be fed orally within the first month is a predictor of poor outcomes with high frequency of gastrointestinal and respiratory comorbidities.