Laparoscopic approach to acute small bowel obstruction: Review of 1061 cases - Surgical Endoscopy

Background

Acute small bowel obstruction has previously been considered a relative contraindication for laparoscopic management. As experience with laparoscopy grows, more surgeons are attempting laparoscopic management for this indication. The purpose of this study is to define the outcome of laparoscopy for acute small bowel obstruction through an analysis of published cases.

Methods

A literature search of the Medline database was performed using the key words laparoscopy and bowel obstruction. Further articles were identified from the reference lists of retrieved literature. Only English language studies were reviewed. We excluded studies that included patients with chronic abdominal pain, chronic recurrent small bowel obstruction, or gastric or colonic obstruction, when the data specific to acute small bowel obstruction could not be extracted. Data was analyzed based on an intention to treat.

Results

Nineteen studies from between 1994 and 2005 were identified. Laparoscopy was attempted in 1061 patients with acute small bowel obstruction. The most common etiologies of obstruction included adhesions (83.2%), abdominal wall hernia (3.1%), malignancy (2.9%), internal hernia (1.9%), and bezoars (0.8%).

Laparoscopic treatment was possible in 705 cases with a conversion rate to open surgery of 33.5%. Causes of conversion were dense adhesions (27.7%), the need for bowel resection (23.1%), unidentified etiology (13.0%), iatrogenic injury (10.2%), malignancy (7.4%), inadequate visualization (4.2%), hernia (3.2%), and other causes (11.1%).

Morbidity was 15.5% (152/981) and mortality was 1.5% (16/1046). There were 45 reported recognized intraoperative enterotomies (6.5%), but less than half resulted in conversion. There were, however, nine missed perforations, including one trocar injury, often resulting in significant morbidity. Early recurrence (defined as recurrence within 30 days of surgery) occurred in 2.1% (22/1046).

Conclusion

Laparoscopy is an effective procedure for the treatment of acute small bowel obstruction with acceptable risk of morbidity and early recurrence.

1. Franklin ME Jr, Dorman JP, Pharand D (1994) Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 4:289–296

   Article  PubMed  Google Scholar 

2. Ibrahim IM, Wolodiger F, Sussman B, Kahn M, Silvestri F, Sabar A (1996) Laparoscopic management of acute small-bowel obstruction. Surg Endosc 10:1012–1014

   Article  PubMed  CAS  Google Scholar 

3. Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Laparoscopic management of acute small bowel obstruction. Br J Surg 85:84–87

   Article  PubMed  CAS  Google Scholar 

4. Navez B, Arimont JM, Guiot P (1998) Laparoscopic approach in acute small bowel obstruction. A review of 68 patients. Hepatogastroenterology 45:2146–2150

   PubMed  CAS  Google Scholar 

5. El Dahha AA, Shawkat AM, Bakr AA (1999) Laparoscopic adhesiolysis in acute small bowel obstruction: a preliminary experience. JSLS 3:131–135

   PubMed  CAS  Google Scholar 

6. Strickland P, Lourie DJ, Suddleson EA, Blitz JB, Stain SC (1999) Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 13:695–698

   Article  PubMed  CAS  Google Scholar 

7. Rosin D, Kuriansky J, Bar Zakai B, Shabtai M, Ayalon A (2000) Laparoscopic approach to small-bowel obstruction. J Laparoendosc Adv Surg Tech A 10:253–257

   Article  PubMed  CAS  Google Scholar 

8. Al-Mulhim AA (2000) Laparoscopic management of acute small bowel obstruction. Experience from a Saudi teaching hospital. Surg Endosc 14:157–160

   Article  PubMed  CAS  Google Scholar 

9. Chosidow D, Johanet H, Montariol T, Kielt R, Manceau C, Marmuse JP, Benhamou G (2000) Laparoscopy for acute small-bowel obstruction secondary to adhesions. J Laparoendosc Adv Surg Tech A 10:155–159

   PubMed  CAS  Google Scholar 

10. Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V (2000) Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Surg Endosc 14:478–483

    Article  PubMed  CAS  Google Scholar 

11. Agresta F, Piazza A, Michelet I, Bedin N, Sartori CA (2000) Small bowel obstruction. Laparoscopic approach. Surg Endosc 14:154–156

    Article  PubMed  CAS  Google Scholar 

12. Sato Y, Ido K, Kumagai M, Isoda N, Hozumi M, Nagamine N, Ono K, Shibusawa H, Togashi K, Sugano K (2001) Laparoscopic adhesiolysis for recurrent small bowel obstruction: long-term follow-up. Gastrointest Endosc 54:476–479

    Article  PubMed  CAS  Google Scholar 

13. Levard H, Boudet MJ, Msika S, Molkhou JM, Hay JM, Laborde Y, Gillet M, Fingerhut A, French Association for Surgical Research (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71:641–646

    Article  PubMed  CAS  Google Scholar 

14. Chopra R, McVay C, Phillips E, Khalili TM (2003) Laparoscopic lysis of adhesions. Am Surg 69:966–968

    PubMed  Google Scholar 

15. Suzuki K, Umehara Y, Kimura T (2003) Elective laparoscopy for small bowel obstruction. Surg Laparosc Endosc Percutan Tech 13:254–256

    Article  PubMed  Google Scholar 

16. Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151

    Article  PubMed  CAS  Google Scholar 

17. Borzellino G, Tasselli S, Zerman G, Pedrazzani C, Manzoni G (2004) Laparoscopic approach to postoperative adhesive obstruction. Surg Endosc 18:686–690

    Article  PubMed  CAS  Google Scholar 

18. Liauw JJ, Cheah WK (2005) Laparoscopic management of acute small bowel obstruction. Asian J Surg 28:185–188

    Article  PubMed  Google Scholar 

19. Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19:464–467

    Article  PubMed  CAS  Google Scholar 

20. Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH 3rd (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1:259–262

    Article  PubMed  CAS  Google Scholar 

21. Nagle A, Ujiki M, Denham W, Murayama K (2004) Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 187:464–470

    Article  PubMed  Google Scholar 

22. Asbun HJ, Pempinello C, Halasz NA (1989) Small bowel obstruction and its management. Int Surg 74:23–27

    PubMed  CAS  Google Scholar 

23. Williams SB, Greenspon J, Young HA, Orkin BA (2005) Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum 48:1140–1146

    Article  PubMed  Google Scholar 

24. Fevang BT, Fevang J, Lie SA, Soreide O, Svanes K, Viste A (2004) Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 240:193–201

    Article  PubMed  Google Scholar 

25. Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906

    Article  PubMed  CAS  Google Scholar 

26. Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181

    Article  PubMed  Google Scholar 

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Authors and Affiliations

1. Department of Surgery, University of Mississippi, Jackson, MS, USA

   Bashar Ghosheh

2. Department of Surgery, Georgetown University, Washington, DC, USA

   J. R. Salameh

3. 1625 N. George Mason Drive, Suite 334, Arlington, VA, 22205, USA

   J. R. Salameh

Corresponding author

Correspondence to J. R. Salameh.

Cite this article

Ghosheh, B., Salameh, J.R. Laparoscopic approach to acute small bowel obstruction: Review of 1061 cases. Surg Endosc 21, 1945–1949 (2007). https://doi.org/10.1007/s00464-007-9575-3

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• Received: 18 March 2007

• Revised: 29 June 2007

• Accepted: 29 August 2007

• Published: 19 September 2007

• Issue Date: November 2007

• DOI: https://doi.org/10.1007/s00464-007-9575-3

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