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Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings.

Our objective was to determine the incidence, risk factors, and outcome of small bowel obstruction in patients undergoing radical hysterectomy as therapy for a nonadnexal gynecologic malignancy. Using a computerized search of discharge data from January 1, 1981 to January 1, 1991, 113 patients were identified who had undergone a radical hysterectomy as part of initial therapy for a nonadnexal gynecologic malignancy. Complete records were available for 98 patients who comprised the study population. For purposes of data accrual, patients were separated into three groups: radical hysterectomy without concomitant radiotherapy (Group I, n = 60), patients receiving pelvic radiation following radical hysterectomy (Group II, n = 20), and a third group with preceding pelvic radiation (Group III, n = 18). Postoperative small bowel obstruction (SBO) occurred in 3 (5%) of Group I patients, all of which required surgical management. The incidence of SBO was significantly higher (P < 0.05) in the groups that had received concomitant radiotherapy (4 of 20 (20%) in Group II; 4 of 18 (22%) in Group III). Importantly, none of these patients had recurrent disease noted at the time of SBO occurrence. Three Group II patients and no Group III patients received operative management of their SBO. Findings at surgery for the SBO were similar in all cases: minimal incisional adhesions but extensive matted small bowel adherent to the pelvic operative sites. We concluded that small bowel obstructions due to intraperitoneal adhesions are frequent sequelae of radical hysterectomy, being more common if concomitant radiotherapy is given. Further investigations as to ways to limit post-radical hysterectomy adhesion formation are needed.