Laparoscopic treatment of acute adhesive small bowel obstruction compared with conventional method

Abstract

Abstract: Intestinal obstTUction is an abdominal emergency, and it is a common reason for surgical referral. There are many studies that demonstrated the feasibility of laparoscopy in management of acute adhesive small bowel obstruction. Although laparoscopy is a good technique for many intra-abdominal operative procedures, laparoscopy was contraindicated in abdominal surgical emergency, and intestinal obstTUction. It remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from this technique or not. 104 patients were included in this study and were divided into two groups, each group included 52 patients. Each group was treated by one surgical technique from those mentioned above and the results were compared with each other. Complete laparoscopic treatment was performed in 25 patients (48.1%). Major intra-operative complications occurred in 15 patients in the LAP group and 8 patients in CONV group (p= 0.156). Intra-operative perforations were more frequent inpatients who had more than one previous laparotomy (P=O.066). Postoperative complications occurred in 10 patients (19.2%) in the LAP group and in 21 patients (40.4%), who had conventional surgery (P=0.032). Bowel movements started 3.5 days after operation in the LAP group, and 4.4 days after conventional operation (P=O.001). The length of hospital stay was 11.3 and 18.1 days respectively (P=0.001). From this study we can conclude than laparoscopic treatment of acute SBO was feasible in about half of these patients, morbidity is lower, hospital stay is shorter than patients with open surgery, and postoperative recovery and resumption of a normal diet is faster, but the risk of intra-operative complications increased. A laparoscopic approach seems justified in subset of patients.