A retrospective study of risk factors for small bowel obstruction after hysterectomy

Background and Objectives: The purpose of this study was to evaluate the incidence of small bowel obstruction (SBO) following hysterectomy and to identify factors that may increase the risk of SBO by route of hysterectomy. Methods: A retrospective review of the electronic medical records of all hysterectomies completed between January 2011 through July 2013 at our institution was performed. Information on patient demographics, comorbid conditions, and surgical characteristics were collected. All cases were reviewed for documentation of SBO in the immediate or remote postoperative period, up to 5 years post-hysterectomy. Results: Between January 2011 and July 2013, 1630 hysterectomies were performed at Montefiore Medical Center. A minimally invasive technique was employed for 49.8%, including 15.7% vaginal and 33.9% laparoscopic hysterectomies. Of these 1630 cases, 40 SBO’s were documented; 30 after an abdominal approach and 10 after a minimally invasive approach. The overall incidence of SBO was 2.4%. A multivariable analysis adjusting for potential confounders demonstrated lower odds of SBO for the minimally invasive approaches combined, compared to abdominal hysterectomy (0.44, 95% confidence interval, 0.20, 0.98, p =.0444). Additional variables independently associated with development of SBO included intra-operative bowel injury and malignancy, whereas intra-operative blood loss and lysis of adhesions were not independently associated with SBO. Conclusions: After adjusting for confounders including malignancy, abdominal hysterectomy was associated with a significantly higher risk for SBO when compared to minimally invasive hysterectomy. Our study adds to the body of literature supporting a minimally invasive approach to hysterectomy when feasible.