Adhesion-Related Bowel Obstruction After Hysterectomy for Benign Conditions
Bibliographic record
Abstract
OBJECTIVE: To evaluate the occurrence of small bowel obstruction after hysterectomy. METHODS: Analysis of 326 cases of women who were admitted with a diagnosis of small bowel obstruction during the period 1998-2005. Among cases with small bowel obstruction after hysterectomy for benign conditions, we evaluated the type and technique of hysterectomy and whether the parietal peritoneum was sutured at the completion of the procedure. RESULTS: The main causes of bowel obstruction were intra-abdominal adhesions (41.9%) and abdominal malignancy (40.1%). After excluding oncologic cases, we found that, of 135 cases of adhesion-related small bowel obstruction, gynecologic operations played the largest role in the occurrence of bowel obstruction (n=68, 50.4%). Among all gynecologic operations for benign conditions, total abdominal hysterectomy (TAH) was the most common cause of small bowel obstruction (13.6 per 1,000 TAHs). We did not encounter small bowel obstruction after laparoscopic supracervical hysterectomy. The reduction in absolute risk of small bowel obstruction from TAH to laparoscopic supracervical hysterectomy is 13.6 per 1,000 cases; 73 patients would undergo laparoscopic supracervical hysterectomy to prevent one small bowel obstruction. The median interval between TAH and small bowel obstruction was 4 years. The adhesions were adherent to the previous laparotomy incision in 27 cases (75%) and to the vaginal vault in nine cases (25%). Peritoneal closure was not associated with small bowel obstruction. CONCLUSION: Hysterectomy plays a major role in the occurrence of adhesion-related small bowel obstruction. Closure of the parietal peritoneum does not contribute to the occurrence of adhesion-related small bowel obstruction, and small bowel obstruction rarely occurs after laparoscopic supracervical hysterectomy. LEVEL OF EVIDENCE: II-3.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".