Adhesional Small Bowel Obstruction Following Anti-Reflux Surgery In Children – Comparison of 232 Laparoscopic and Open Fundoplications

Abstract

Adhesions are a major cause of morbidity following abdominal surgery. There is debate whether laparoscopic abdominal surgery results in a lower incidence of adhesional small bowel obstruction (ASBO) compared with the equivalent open procedure. The aim of this study was to study the incidence of ASBO following laparoscopic and open anti-reflux surgery. The case notes of all patients undergoing fundoplication (open or laparoscopic) between November 1997 and November 2005 were reviewed retrospectively. Laparotomy due to ASBO was chosen as the endpoint as it was a clearly identifiable and incontrovertible endpoint. The incidence of ASBO following each operation was compared using Fisher's exact test (p<0.05 was considered significant). A total of 232 patients were analysed. There were no ASBO following 170 laparoscopic fundoplications. There were 5 episodes (8.1%) of ASBO in 3 patients (4.8%) following 62 open procedures. Two of the three patients who developed ASBO after open fundoplication had undergone concomitant Ladd's procedure. There was no significant difference in the rate of ASBO following laparoscopic and open fundoplication alone. ASBO is a serious complication following any abdominal surgery. The data from this study indicate that the risk of ASBO following laparoscopic fundoplication is negligible. Although there is a suggestion that the risk of ASBO is lower following laparoscopic fundoplication compared with open fundoplication, there was no significant difference between the two groups as Ladd's procedure was performed in 2 of the open cases.