Postoperative adhesions after abdominal surgery in children: a pilot study in the Philippines

Abstract

BackgroundPostoperative adhesions (POAs) causing mechanical bowel obstruction is a challenging problem for children who underwent prior abdominal surgeries. Unlike in adults, the role of conservative management remains controversial and children tend to require re-operation. However, despite the longer lifetime risk inherent to the pediatric population, studies are still lacking to come up with guidelines on diagnosis and management. This study aimed to review the profiles and outcomes of patients who underwent surgery for POA and to identify significant risk factors.MethodsThis was a retrospective review of 172 patients admitted at the Philippine General Hospital from 2010 to 2018 with the diagnosis of POA. Patients who did not undergo surgery and patients who had a different cause of bowel obstruction with the adhesions being only incidental were excluded from the study.ResultsNinety-one patients were included in the study. The mean age at surgery was 92.32 months and the male:female ratio was 2.8:1. The most common primary diagnoses were appendicitis, intussusception, and abdominal trauma. POA occurred within the first postoperative year in 63%. The 30-day morbidity and mortality rates were 9.89% and 7.69%, respectively. The most common complications were fascial and anastomotic dehiscences, and sepsis was the most common cause of death. Stoma creation during the index operation, and the presence of bowel gangrene, intestinal resection, and stoma creation during the surgery for POA were statistically significant risk factors for morbidity and mortality.ConclusionThe findings in this study support the experience in literature that timely operative intervention can prevent bowel strangulation in cases of mechanical bowel obstruction from POA. However, more data and studies are recommended to arrive at an evidence-based guideline in the management of these children.