SP5.8 Laparoscopy for small bowel obstruction improves outcomes

Abstract

Abstract Aims Adhesional small bowel obstruction is the commonest cause of emergency general surgery. Fewer than 20% of cases are started laparoscopically, but there is huge variability across the country from 80% in some units to 0% in others. This study examines whether the laparoscopic approach reduces length of stay and mortality. Methods The national NELA database was interrogated to identify patients operated for small bowel obstruction due to adhesions. Post-operative length of stay and mortality were analysed according to surgical approach. Results 20,597 patients with small bowel obstruction due to adhesions were identified; overall 30-day mortality was 6.2%. 3870 of these 20,597 cases (18.5%) were started laparoscopically. Mortality in this group was 3.2% compared with 7.0% in the laparotomy group. This association was also demonstrated in patients with predicted mortality <5% (0.9% v 1.4%) and with predicted mortality <10% (1.6% v 2.5%). In the laparoscopic group, more patients were discharged within 3 days (23% v 3%) and within 7 days (58% v 34%) compared to the laparotomy group. When surgery could be completed laparoscopically, all of these associations became stronger – mortality in this group was 1.9%, and 40% of patients were discharged within 3 days. Conclusions The laparoscopic approach to adhesional small bowel obstruction is safe and effective, and is associated with shorter length of stay and reduced mortality. The association holds even in patients converted to open surgery, and is not dependent on patient selection. Laparoscopy should be the approach of choice for adhesional small bowel obstruction.