S3047 Surgical vs Conservative Management of Patients With Adhesive Small Bowel Obstruction: An Updated Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Adhesive small bowel obstruction (ASBO) is one of the most common reasons for hospitalization due to intestinal obstruction. While conservative management is typically the initial approach in clinically stable patients, it is associated with high recurrence rates. However, considerable variability exists in clinical practice. We conducted a systematic review and meta-analysis (SRMA) comparing surgical versus conservative management of ASBO, focusing on recurrence and complication outcomes. Methods: The SRMA was conducted in accordance with PRISMA guidelines. Data on ASBO recurrence and complication rates were extracted from studies that met predefined inclusion criteria. Risk of bias was evaluated using the Cochrane Risk of Bias Tool (RoB 1) for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Odds ratios (ORs) with 95% confidence intervals (CI) was calculated using random-effect models, and heterogeneity was assessed using the I² statistic. Results: A total of 10 comparative studies encompassing 46,212 patients were included in the analysis. Surgical management was associated with a significantly lower risk of recurrence compared to conservative management (OR: 0.52; 95% CI: 0.38–0.70; P < 0.0001), despite notable heterogeneity (I² = 85%). While the incidence of overall complications appeared higher in the surgical group, this difference did not reach statistical significance (OR: 2.23; 95% CI: 0.92–5.40; P = 0.08), with moderate heterogeneity observed (I² = 65%). These findings suggest that surgical intervention may be preferable in reducing long-term recurrence, without a definitive increase in short-term complication rates. Conclusion: ASBO is a frequent complication of prior abdominal surgery, resulting from fibrous intra-abdominal adhesions. These findings underscore an important clinical consideration: while surgery may offer superior recurrence prevention, it does not appear to significantly increase complication risk. Management strategies should therefore be individualized, balancing patient stability, surgical history, and institutional resources to optimize outcomes.
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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 | 0.012 | 0.029 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.031 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 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".