In a further multicenter prospective study [24] including 286 patients operated for ASBO and followed

up for 41 months, cumulative incidence of overall recurrence was 15.9%, and for surgically managed recurrence 5.8%. The risk factors for the overall recurrences were age <40 years (hazard ratio [HR], 2.97), adhesion or matted adhesion (HR, 3.79) and, for the AZD1390 chemical structure surgically managed: adhesions or matted adhesions (HR, 3.64), and postoperative surgical complications (HR, 5.63). In this study the number of recurring patients (21%) in absence of resection is very high. The beneficial effect of intestinal resection might relate to the decrease of the traumatized intestinal serosa area. In this way, it may be hypothesized that adhesive postoperative SBO frequency is linked to the extent of both the parietal peritoneal trauma (incision and site) and the intestinal serosa. Miller et al. [25] in a review of 410 patients accounting for 675 admissions found that a history of colorectal surgery and vertical incisions tended to predispose to multiple matted adhesions rather than an obstructive band. They conclude that the likelihood of reobstruction increases and the time to reobstruction decreases with increasing number of previous episodes of obstruction. Patients with matted adhesions have a greater recurrence rate than those with band adhesions. These authors failed to find reliable clinical indicators of impending

strangulation selleck kinase inhibitor and the optimum length of a non operative trial for patients with acute ASBO remains controversial. Fevang et al. described the long term prognosis of 500 patients operated for ASBO with a median follow-up of 10 years and a maximum follow-up time of 40 years [26]. The cumulative recurrence rate for patients operated once for ASBO was 18% after 10 years and 29% at 30 years. For patients admitted several times for ASBO, the relative risk of recurrent ASBO increased with increasing number of prior ASBO episodes. The cumulative recurrence rate reached 81% for patients with 4 or more ASBO admissions. Other factors influencing the recurrence

rate were the method of treatment of the last previous ASBO episode (conservative versus surgical) and the number of abdominal operations prior to the initial ASBO Gefitinib mw operation. The authors concluded that the risk of recurrence increased with increasing number of ASBO episodes. Most recurrent ASBO episodes occur within 5 years after the previous one, but a considerable risk is still present 10 to 20 years after an ASBO episode. Surgical treatment see more decreased the risk of future admissions for ASBO, but the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment. Thus surgical treatment of a recurrent ASBO episode was associated with a significantly decreased risk of having conservatively treated ASBO episodes in the future, but the need for subsequent surgery for ASBO was similar regardless of the method of treatment.