BACKGROUND:Patients with partial adhesive small-bowel obstruction are usually managed conservatively, receiving intravenous hydration and nothing by mouth. Previous studies have suggested that this approach is associated with longer hospital stays and an increased risk of delayed surgery. We conducted a randomized controlled trial to see if combining standard conservative treatment with oral administration of a laxative, a digestant and a defoaming agent would reduce the frequency of subsequent surgical intervention and reduce the length of hospital stay. METHODS: We identified 144 consecutive patients admitted between February 2000 and July 2001 with adhesive partial small-bowel obstruction and randomly assigned 128 who met the inclusion criteria to either thecontrol group (intravenous hydration, nasogastric-tube decompression and nothing by mouth) or the intervention group (intravenous hydration, nasogastric-tube decompression and oral therapy with magnesium oxide, Lactobacillus acidophilus and simethicone). The primary outcome measures were the number of patients whose obstruction was successfully treated without surgery and the length of hospital stay. We also monitored rates of complications and recurring obstructions. RESULTS: Of the 128 patients, 63 were in the control group and 65 in the intervention group; the mean ages were 54.4 (standard deviation [SD] 15.9) years and 53.9 (SD 16.3) years respectively. Most of the patients were male. More patients in the intervention group than in the control group had successful treatment without surgery (59 [91%] v. 48 [76%], p = 0.03; relative risk 1.19, 95% confidence interval 1.03-1.40). The mean hospital stay was significantly longer among patients in the control group than among those in the intervention group (4.2 [SD 2.7] v. 1.0 [SD 0.7] days, p < 0.001). The complication and recurrence rates did not differ significantly between the 2 groups. INTERPRETATION: Oral therapy with magnesium oxide, L. acidophilus and simethicone was effective in hastening the resolution of conservatively treated partial adhesive small-bowel obstruction and shortening the hospital stay.
RCT Entities:
BACKGROUND:Patients with partial adhesive small-bowel obstruction are usually managed conservatively, receiving intravenous hydration and nothing by mouth. Previous studies have suggested that this approach is associated with longer hospital stays and an increased risk of delayed surgery. We conducted a randomized controlled trial to see if combining standard conservative treatment with oral administration of a laxative, a digestant and a defoaming agent would reduce the frequency of subsequent surgical intervention and reduce the length of hospital stay. METHODS: We identified 144 consecutive patients admitted between February 2000 and July 2001 with adhesive partial small-bowel obstruction and randomly assigned 128 who met the inclusion criteria to either the control group (intravenous hydration, nasogastric-tube decompression and nothing by mouth) or the intervention group (intravenous hydration, nasogastric-tube decompression and oral therapy with magnesium oxide, Lactobacillus acidophilus and simethicone). The primary outcome measures were the number of patients whose obstruction was successfully treated without surgery and the length of hospital stay. We also monitored rates of complications and recurring obstructions. RESULTS: Of the 128 patients, 63 were in the control group and 65 in the intervention group; the mean ages were 54.4 (standard deviation [SD] 15.9) years and 53.9 (SD 16.3) years respectively. Most of the patients were male. More patients in the intervention group than in the control group had successful treatment without surgery (59 [91%] v. 48 [76%], p = 0.03; relative risk 1.19, 95% confidence interval 1.03-1.40). The mean hospital stay was significantly longer among patients in the control group than among those in the intervention group (4.2 [SD 2.7] v. 1.0 [SD 0.7] days, p < 0.001). The complication and recurrence rates did not differ significantly between the 2 groups. INTERPRETATION: Oral therapy with magnesium oxide, L. acidophilus and simethicone was effective in hastening the resolution of conservatively treated partial adhesive small-bowel obstruction and shortening the hospital stay.
Authors: Yaser M K Baghdadi; Asad J Choudhry; Naeem Goussous; Mohammad A Khasawneh; Stephanie F Polites; Martin D Zielinski Journal: J Surg Res Date: 2015-12-11 Impact factor: 2.192
Authors: Lucas W Thornblade; Francys C Verdial; Matthew A Bartek; David R Flum; Giana H Davidson Journal: J Gastrointest Surg Date: 2019-02-20 Impact factor: 3.452
Authors: Fausto Catena; Salomone Di Saverio; Federico Coccolini; Luca Ansaloni; Belinda De Simone; Massimo Sartelli; Harry Van Goor Journal: World J Gastrointest Surg Date: 2016-03-27
Authors: Fausto Catena; Salomone Di Saverio; Michael D Kelly; Walter L Biffl; Luca Ansaloni; Vincenzo Mandalà; George C Velmahos; Massimo Sartelli; Gregorio Tugnoli; Massimo Lupo; Stefano Mandalà; Antonio D Pinna; Paul H Sugarbaker; Harry Van Goor; Ernest E Moore; Johannes Jeekel Journal: World J Emerg Surg Date: 2011-01-21 Impact factor: 5.469
Authors: Raphael P H Meier; Wassila Oulhaci de Saussure; Lorenzo A Orci; Eveline M Gutzwiller; Philippe Morel; Frédéric Ris; Frank Schwenter Journal: World J Surg Date: 2014-12 Impact factor: 3.352
Authors: Salomone Di Saverio; Fausto Catena; Federico Coccolini; Marica Galati; Nazareno Smerieri; Walter L Biffl; Luca Ansaloni; Gregorio Tugnoli; George C Velmahos; Massimo Sartelli; Cino Bendinelli; Gustavo Pereira Fraga; Michael D Kelly; Frederick A Moore; Vincenzo Mandalà; Stefano Mandalà; Michele Masetti; Elio Jovine; Antonio D Pinna; Andrew B Peitzman; Ari Leppaniemi; Paul H Sugarbaker; Harry Van Goor; Ernest E Moore; Johannes Jeekel Journal: World J Emerg Surg Date: 2013-10-10 Impact factor: 5.469
Authors: Pepijn Krielen; Barend A van den Beukel; Martijn W J Stommel; Harry van Goor; Chema Strik; Richard P G Ten Broek Journal: World J Emerg Surg Date: 2016-10-06 Impact factor: 5.469