Abstract
Background: Laparotomy (open surgery) is considered the standard approach for acute small bowel obstruction (ASBO). However, with the advent of minimally invasive surgery, the laparoscopic approach is gaining popularity. There is no consensus on the appropriate setting for laparoscopic therapy for small bowel obstruction (SBO).Aim and objectives: The purpose of this study is to evaluate the outcomes of laparoscopic surgery for ASBO.Patients and methods: We retrospectively evaluated the prospectively collected data of all the 38 patients who had undergone laparoscopy for ASBO, performed by a single surgeon at our institution, due to adhesions (30 patients), internal hernias (five patients), midgut malrotation (one patient), ileo-ileal intussusception (one patient), and superior mesenteric artery (SMA) syndrome (one patient) from 2012 to 2020. Data were extracted from the hospital electronic medical records (EMR) for the following parameters of each individual patient: age, sex, clinical presentation, preoperative investigation findings, final diagnosis, surgical details, operating time, time to postoperative oral feeds, length of hospital stay, complications, recurrences, and time taken to resume normal activity. A preoperative abdominal contrast-enhanced computed tomography (CECT) was performed in all the cases. Patients with peritonitis and septic shock were excluded from the study. Results: The mean age of the 38 patients was 58 years (ranged between 33 and 83 years) with a standard deviation (SD) of 16.5. The mean age of the female patients in the study was 60.5 years with an SD of 16.6, while the mean age of the male patients was 54.9 years (SD = 16.2). The age difference between male and female patients in the study was not statistically significant (p = 0.36). The mean operating time was 74.4 minutes (range: 60-90 minutes, with an SD of 7.2). The mean time to oral liquid/soft diet was 2.5 days. The mean postoperative stay was 5.7 days. Three patients (8%) underwent conversion to open surgery, out of which two patients had multiple complex bowel-to-bowel and bowel-to-parietes adhesions, and in one patient, massive distension of small bowel caused technical difficulties.Conclusion: Laparoscopic management of ASBO is feasible, effective, and safe. Optimum surgical techniques, the surgeon's experience with the procedure, and stringent patient selection criteria enable a high probability of success.
Highlights
Acute small bowel obstruction (ASBO) is one of the most common causes of emergency hospital admissions for acute abdominal pain
Out of five patients (13%) operated for internal hernia, two had obstructed paraduodenal hernias, two had obstructed left broad ligament hernia, and one had an obstructed internal hernia caused by entrapment of ileum in an abnormal recess
One patient had ileo-ileal intussusception, and two presented with acute duodenal obstruction caused by midgut malrotation and superior mesenteric artery (SMA) syndrome
Summary
Acute small bowel obstruction (ASBO) is one of the most common causes of emergency hospital admissions for acute abdominal pain. Postoperative intra-abdominal adhesions occur in 55%-80% of the cases with small bowel obstruction (SBO) [1,2]. Common symptoms of SBO are abdominal colicky pain, abdominal distension, constipation, obstipation in some, and vomiting. The clinical signs of SBO include tympanic abdominal distension, tenderness, hyperperistalsis, and empty rectum. The relevant investigations include a plain x-ray of the abdomen in standing/erect position, which shows the dilated gasfilled small bowel loops and may show multiple air-fluid levels in characteristic "stepladder pattern" in the central abdomen. Laparotomy (open surgery) is considered the standard approach for acute small bowel obstruction (ASBO). There is no consensus on the appropriate setting for laparoscopic therapy for small bowel obstruction (SBO)
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