Laparoscopic versus Open Approach of Small Bowel Obstruction due to Food Bolus: A Comparative Study

Abstract

Introduction: Food bolus is an uncommon cause of small bowel obstruction, and the traditional treatment is by laparotomy. With the mastery of minimally invasive surgery, laparoscopic management of small bowel obstruction has been demonstrated to be feasible and safe.Aim: A retrospective comparative study was conducted to compare patients treated by conventional open approach vs. laparoscopic approach in terms of operation time, postoperative complications, hospital stay and recurrence rate.Patients and Method: Between November 1998 to November 2003, patients with the diagnosis of small bowel obstruction with or without operation were retrieved from the hospital computer record. Those operated patients will have their operation record reviewed to identify all food bolus obstruction cases. The case notes of these patients were study to collect data for analysis.Result: A total of 496 cases of small bowel obstruction due to variable causes were found. Only 24 cases (4.8%) were due to food bolus obstruction. 14 cases were treated by conventional open method (OP group) and 10 cases were treated by laparoscopic approach (LAP group). Three cases in LAP group were converted to open by minilaparotomy wound. Both groups were comparable in age and sex. The median operation time was 47.5 min (25–65) in LAP group versus 65 min (30–150) in OP group, P=0.068. The median hospital stay was 4.0 days (3–14) in LAP group versus 7.5 days (5–120) in OP group, P=0.009. There was no postoperative complication in LAP group whereas OP group encountered four complications, P=0.038. There was no recurrence in both groups after median follow up time of 20 months (3–54).Conclusion: Small bowel obstruction due to food bolus is uncommon. Laparoscopic approach was safe and feasible in managing this condition with shorter operation time, shorter hospital stay and less complication than conventional open method.