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Bowel obstructions and incisional hernias following trauma laparotomy and the nonoperative therapy of solid organ injuries: A retrospective population-based analysis

Li, Ting MD; Robertson-More, Connal MD; Maclean, Anthony R. MD; Dixon, Elijah MD, MSc; Navsaria, Pradeep MD; Nicol, Andrew J. MD, PhD; Kirkpatrick, Andrew W. MD, MSc; Ball, Chad G. MD, MSc

Journal of Trauma and Acute Care Surgery: September 2015 - Volume 79 - Issue 3 - p 386–392
doi: 10.1097/TA.0000000000000765
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BACKGROUND Small bowel obstruction (SBO) and incisional hernia (IH) represent the most common long-term complications of laparotomy. They may also be more common among injured patients than for elective/nontrauma emergency scenarios. Unfortunately, the population-based incidence of SBO and IH following trauma laparotomy is unknown. The aim of this study was to define the long-term, population-based incidence of SBO and IH following both trauma laparotomy as well as the nonoperative therapy of solid organ injuries.

METHODS All injured patients admitted to a Level 1 trauma center (2002–2013) who underwent (1) a laparotomy or nonoperative care of (2) splenic and/or (3) hepatic injuries were linked with the Alberta Health Services Discharge Database to identify all readmissions for subsequent SBO and/or IH within the province. Standard statistical methodology was used (p < 0.05).

RESULTS Of 484 patients who underwent a trauma laparotomy, 29 (6%) and 42 (9%) required readmission for SBO and IH, respectively (0.13 SBO and 0.10 IH admissions per patient year). Patients who underwent nonoperative management of their liver and/or spleen injuries displayed long-term SBO rates of 1% (6 of 619) and 0.7% (4 of 606), respectively. The rate of SBO and IH in patients with unnecessary laparotomies was equivalent to therapeutic procedures (p = 0.183). Topical hemostatic agents, repeat laparotomies, and injury pattern did not alter SBO or IH rates (p > 0.05).

CONCLUSION The population-based, long-term rate of clinically relevant SBO and IH following trauma laparotomies is 15%. This increases to 19% on a per-admission basis. Nontherapeutic scenarios, injury pattern, topical hemostatics, and open abdomens did not alter complication rates.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the Department of Surgery (T.L., C.R.-M., A.R.M., E.D., A.W.K., C.G.B.), University of` Calgary, Calgary, Alberta, Canada; Department of Surgery (P.N., A.J.N.), University of Cape Town, Cape Town, South Africa.

Submitted: December 8, 2014, Revised: May 3, 2015, Accepted: May 18, 2015.

Address for reprints: Chad G. Ball, MD, MSc, Department of Surgery University of Calgary Foothills Medical Centre, 1403-29th St, Northwest Calgary, Alberta, Canada T2N 2T9; email: Ball.Chad@gmail.com.

© 2015 Lippincott Williams & Wilkins, Inc.