Management and outcome variability in hernia-related small bowel obstruction: insights from the SnapSBO study

Background: Small bowel obstruction (SBO) due to hernia remains a prevalent surgical emergency disproportionately affecting elderly and co-morbid populations. Limited high-quality data exist to guide evidence-informed interventions for hernia-related SBO. This study explored the management and outcomes of hernia-related SBO (hSBO) for patients captured in European Society for Trauma and Emergency Surgery (ESTES) SnapSBO database. Methods: SnapSBO is a prospective multicentre time-bound study that accrued consecutive inpatient admissions between November 2023 and May 2024. The present analysis was restricted to patients with abdominal wall hernias. Management pathways were categorized as direct to surgery (DTS), successful non-operative management (NOM), or surgery after trial of NOM (NOM-T). Outcomes of interest included complications, 30-day in-hospital mortality, length of hospital stay (LOS), and functional recovery assessed through patient-reported outcome measures (PROMs) using the PRO-diGI tool. Results: Among 1737 patients, SBO due to abdominal wall hernia was noted in 386. The median patient age was 73 (range 16-98) years, with 64.8% of patients aged > 65 years. Primary inguinal/abdominal wall hernias were the most common (62.2%). Of the patients, 51.6% were categorized as DTS, where 17.1% required surgery after NOM-T. NOM was successful in 31.2% of patients. Parastomal hernia management led to the highest complication rate (57.1%) and prolonged postoperative LOS (mean(standard deviation) 9.1(4.8) days; P = 0.030) compared with other hernia types. Functional recovery measured in 218 patients was significantly worse in those with parastomal hernia than in those with incisional or primary inguinal hernias (mean(standard deviation) bowel function scores 68.6(22.5) versus 83.6(17.6) and 82.0(20.3), respectively; P = 0.009). Conclusion: There is significant variability in practice and outcomes for hSBO management. Patients with parastomal hernias represent a high-risk subgroup. Future research should focus on PROMs and in developing evidence-based, context-specific guidelines for hSBO management.