Abstract

Roughly 60% of all cases of small bowel obstruction are caused by adhesions. Adhesions are a form of internal scar tissue, which develop in over 45–93% of patients who undergo abdominal surgery. With this relatively high incidence, the population at risk for adhesive small bowel obstruction (ASBO) is enormous. Minimally invasive surgery reduces surgical wound surface and thus holds promise to reduce adhesion formation. The use of minimally invasive techniques results in a 50% reduction of adhesion formation as compared to open surgery. However, since ASBO can be caused by just a single adhesive band, it is uncertain whether a reduction in adhesion formation will also lead to a proportional decrease in the incidence of ASBO. Minimally invasive surgery might also improve operative treatment of ASBO, accelerating gastro-intestinal recovery time and lowering the risk of recurrent ASBO associated with adhesion reformation. We will discuss recent evidence on the impact of minimally invasive surgery on the incidence of ASBO and the role of minimally invasive surgery to resolve ASBO. Finally, we will debate additional measures, such as the use of adhesion barriers, to prevent adhesion formation and adhesion-related morbidity in the minimally invasive era.

Highlights

  • As many as 60% of all episodes of small bowel obstruction (SBO) are caused by adhesions [1]

  • We currently investigate the contribution of adhesiolysis and associated intra-operative complications e.g. bleeding, inadvertent enterotomy to the Classification of Intraoperative Complications (CLASSIC)

  • Invasive surgery is associated with only a modest reduction in adhesion-related readmissions and incidence of adhesive small bowel obstruction (ASBO)

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Summary

Introduction

As many as 60% of all episodes of small bowel obstruction (SBO) are caused by adhesions [1]. Surgeons strongly believed in the effectiveness of minimally invasive surgical techniques to reduce adhesion formation and subsequent morbidity [14]. For this reasons adhesion barriers are only seldomly used in minimally invasive surgery [15], and are believed to be needed only in open surgery. Despite good evidence of effective reduction of adhesion formation and subsequent adhesion-related morbidity, the use of adhesion barriers in open surgery is limited [16]. A reduction in adhesion formation, does not necessarily correlate with a proportionate reduction in the risk of ASBO; a single adhesive band may cause a life-threatening bowel obstruction, whereas extensive dense abdominal adhesions may be asymptomatic [18]. We end with a contemplation on the awareness of adhesion-related complications and the value of adhesion barriers in minimally invasive surgery

The problem of adhesive small bowel obstruction
Impact of minimally invasive surgery on morbidity of ASBO
Management of adhesive small bowel obstruction
Role of minimally invasive surgery in the management of ASBO
Awareness of adhesions formation by minimally invasive surgery
Adhesion reduction strategies
Findings
Conclusions
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