Manual repositioning of the small bowel and omentum prevents early postoperative small bowel obstruction after laparoscopic colorectal surgery: a propensity score-matched study

Background Early postoperative small bowel obstruction (EPSBO) is a common complication after colorectal cancer surgery, even with minimally invasive techniques. While anti-adhesion agents are used, effective intraoperative strategies remain limited. We evaluated whether manually repositioning the small bowel and omentum to their anatomical positions (Technique R) at the end of surgery reduces the risk of EPSBO. Methods We conducted a two-center, retrospective, propensity score-matched cohort study including 1351 patients who underwent laparoscopic or robot-assisted colorectal cancer surgery between January 2015 and March 2024. Patients were divided into Group A (prior to Technique R, n = 770) and Group B (after adoption of Technique R, n = 581). One-to-one propensity score matching yielded 488 matched pairs. The primary outcome was the incidence of EPSBO within 30 postoperative days. Multivariate logistic regression was performed to identify independent predictors of EPSBO. Results EPSBO occurred in 4.5% of patients in Group A and 1.4% in Group B ( p = 0.003). In multivariate analysis, the omission of Technique R was identified as an independent risk factor (odds ratio [OR]: 3.09; 95% confidence interval [CI] 1.23–7.67; p = 0.016), along with stoma creation (OR: 4.79; p = 0.002) and intra-abdominal abscess (OR: 2.84; p = 0.029). Technique R was not associated with increased operative time or intraoperative complications. Conclusions Omission of Technique R was independently associated with a threefold increase in EPSBO risk. Technique R is a simple, safe, and effective maneuver that significantly improves postoperative outcomes after minimally invasive colorectal surgery and should be considered as a standard operative step.