PWE-268 A systematic review comparing laparoscopic versus open adhesiolysis in patients with adhesional small bowel obstruction

Abstract

Introduction The objective of this article is to evaluate whether surgical outcomes differ between laparoscopic versus open approach for adhesiolysis in patients presenting with adhesional small bowel obstruction (ASBO). Method A systematic review of literature on published comparative studies reporting the surgical outcomes following laparoscopic versus open adhesiolysis for ASBO was undertaken using the principles of meta-analysis. Results Ten retrospective comparative studies on 37,038 patients evaluating the surgical outcomes in patients undergoing laparoscopic versus open adhesiolysis for ASBO were systematically analysed. There were 31778 patients in open group and 5260 patients in laparoscopic group. Laparoscopic adhesiolysis resulted in the reduced risk of post-operative complications [odds ratio, 0.36 (CI, 0.28–0.46), p < 0.00001], post-operative mortality [odds ratio, 0.31 (CI, 0.23–0.42), p < 0.00001] and surgical site infections [odds ratio, 0.22 (CI, 0.12–0.43), p < 0.00001]. In addition, the risk of respiratory complications, cardiac complications, bowel resection, post-operative ileus, venous thromboembolism [odds ratio, 0.36 (CI, 0.24–0.53), p < 0.00001] and infective complications [odds ratio, 0.41 (CI, 0.34–0.49), p < 0.00001] was also lower in patients undergoing laparoscopic adhesiolysis. Length of hospital stay was statistically shorter in laparoscopic group. However, statistical equivalence was seen in variables of re-operation rate, duration of operation and risk of neurological complications. There was significant heterogeneity among included studies. Conclusion Laparoscopic adhesiolysis for ASBO seems to have clinically proven advantage over open approach in terms of several operative and post-operative outcomes measures in patients whom the procedure was considered feasible. Disclosure of interest None Declared.