Predictors of surgical intervention and timing of ileus presentation in patients with adhesive small bowel obstruction.

BACKGROUND: Adhesive small bowel obstruction remains a common long-term complication following abdominal surgery and continues to represent a significant cause of morbidity and healthcare utilization. While several factors contributing to adhesion formation have been described, determinants influencing both the need for surgical intervention and the timing of clinical presentation are not yet fully understood. This study aimed to identify factors associated with surgical management in patients presenting with adhesive ileus after a single prior abdominal operation and to evaluate the relationship between operative duration and the timing of ileus onset. METHODS: This retrospective study included 450 patients (n=450) diagnosed with adhesive ileus at a tertiary care center between January 1, 2021 and January 1, 2026. Patients with mechanical obstruction or multiple prior abdominal surgeries were excluded. Patients were categorized into operative (n=302) and conservative (n=148) management groups. Baseline characteristics, including age, sex, and American Society of Anesthesiologists scores, were comparable between groups (p>0.05). Clinical variables such as type of prior surgery, operative duration, surgical approach, contamination status, and time to ileus presentation were analyzed. Statistical analyses included an independent samples t-test, Chi-square test, Pearson correlation analysis, and multivariate logistic regression. RESULTS: Of the 450 patients, 302 (67.1%) required surgical intervention. Operative duration was significantly longer in the operative group compared to the conservative group (4.3±1.8 vs. 3.1±1.6 h, p=0.003). Open surgery (75% vs. 52%, p=0.037) and contaminated surgical fields (78% vs. 60%, p=0.030) were more frequent in the operative group. The time to ileus presentation was significantly shorter in patients requiring surgery (5.5±1.9 vs. 6.8±2.1 months, p=0.002). A significant inverse relationship was observed between operative duration and time to ileus presentation (r=-0.32, p<0.05). CONCLUSION: Operative duration, surgical approach, and intraoperative contamination are important determinants of surgical management in adhesive ileus. The inverse relationship between operative duration and time to presentation suggests that increased surgical burden may contribute to an earlier onset of clinically significant obstruction. These findings highlight the potential value of surgical factors in risk stratification and post-operative surveillance.