Early Surgery or Conservative Management for Adhesive Small Bowel Obstruction: A Comprehensive Systematic Review of Short- and Long-Term Outcomes

TL;DR

This study compares early surgery versus conservative treatment for adhesive small bowel obstruction, finding that while non-operative management is safe in the short term, early surgery reduces long-term recurrence.

Contribution

The study provides a comprehensive systematic review comparing long-term outcomes of early surgery versus conservative management for adhesive small bowel obstruction.

Findings

Non-operative management in stable adults has comparable short-term outcomes to early surgery but increases recurrence risk.

Early surgery reduces long-term recurrence by 40-60% compared to conservative management.

In infants under one year, conservative management is less effective, with higher surgery rates if delayed beyond 48 hours.

Abstract

Adhesive small bowel obstruction (aSBO) is a common cause of emergency surgical admission, and the optimal initial management between early surgery and conservative non-operative management (NOM) remains debated, particularly regarding recurrence and short-term safety. This systematic review aimed to evaluate short- and long-term outcomes of early operative management compared with conservative treatment for aSBO in adult and paediatric populations. A systematic search of MEDLINE, Embase, Scopus, and Cochrane CENTRAL was conducted from inception to 2025 in accordance with PRISMA guidelines. Nine studies were included. In stable adults, NOM was generally safe with comparable short-term complication and mortality rates to early surgery; however, prolonged delays following NOM failure were associated with increased morbidity and bowel resection. Long-term outcomes consistently favoured early operative management, demonstrating a 40-60% relative reduction in recurrence. Water-soluble contrast protocols improved diagnostic accuracy and NOM success, while specific radiological findings predicted failure. In paediatric patients, NOM was effective in many cases, but infants under one year of age had a higher likelihood of requiring surgery, and delays beyond 48 hours increased bowel resection rates. Overall, NOM is safe for selected patients, but early surgery offers superior long-term recurrence outcomes.

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