pubmed.ncbi.nlm.nih.gov

The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction - PubMed

  • ️Tue Jan 01 2019

The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction

Enric Sebastian-Valverde et al. BMC Surg. 2019.

Abstract

Background: Postoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity.

Methods: A retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO.

Results: 262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38.5%. Patients in the laparoscopic group were younger (p < 0.001), had fewer previous abdominal operations (p = 0.001), lower ASA grade (p < 0.001), and less complex adhesions were found (p = 0.001). Operative time was longer in the open group (p = 0.004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67.9%, p < 0.001), lower mortality (p = 0.026), earlier oral intake (p < 0.001) and shorter hospital stay (p < 0.001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2.89; 95% CI 1.1-7.6; p = 0.033).

Conclusions: Laparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.

Keywords: Intestinal obstruction; Laparoscopy; Length of stay; Small intestine; Tissue adhesions.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Similar articles

Cited by

References

    1. Mancini GJ, Petroski GF, Lin W-C, Sporn E, Miedema BW, Thaler K. Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg. 2008;207:520–526. doi: 10.1016/j.jamcollsurg.2008.04.026. - DOI - PubMed
    1. O’Connor DB, Winter DC. The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc. 2012;26:12–17. doi: 10.1007/s00464-011-1885-9. - DOI - PubMed
    1. Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, Nogueras JJ, Vernava AM, 3rd, Wexner SD. Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc. 2007;21:742–746. doi: 10.1007/s00464-007-9212-1. - DOI - PubMed
    1. Li M-Z, Lian L, Xiao L, Wu W, He Y, Song X. Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg. 2012;204:779–786. doi: 10.1016/j.amjsurg.2012.03.005. - DOI - PubMed
    1. Poves I, Sebastián Valverde E, Puig Companyó S, Dorcaratto D, Membrilla E, Pons MJ, Grande L. Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias. Cir Esp. 2014;92:336–340. doi: 10.1016/j.ciresp.2013.05.008. - DOI - PubMed

MeSH terms