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April 2010

Management of High-Grade Small-Bowel Obstruction

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Surg. 2010;145(4):404. doi:10.1001/archsurg.2010.36

Rocha et al1 present a unique study on the natural history and treatment outcomes of high-grade small-bowel obstruction (HGSBO). Unfortunately, the study missed the opportunity to provide clear and clinically sound take-home messages. There are several reasons for this.

First, there is no description of surgical technique, ie, open vs laparoscopic. Despite the inclusion of exclusively high-grade (and thus presumably more severe or complicated) cases, according to the attending radiologist's interpretation, recurrence rates were significantly lower (9%) than in prior studies (16% in the largest study of SBO to date).2 One possible explanation for this is that surgical treatment was predominantly laparoscopic instead of open, but one cannot be sure. Technique is, therefore, valuable information that is needed to help understand outcomes in the surgical group.3-7