The role of laparoscopic surgery for the management of acute large bowel obstruction

Abstract

The aim of this study was to analyse the outcome of laparoscopic management of large bowel obstruction (LBO). A prospective electronic database (April 2001-June 2009) was used to identify outcomes in consecutive patients presenting with LBO. Twenty-four patients (13 male) median age 68 years (range 56-92 years), ASA grade I (2), II (6), III (14) and IV (2), underwent surgery for LBO secondary to cancer (21) and diverticulosis (3). Supervised trainees performed four operations. Operations included anterior resection (10), Hartmann's resection (6), right/extended hemicolectomy (7) and colectomy with ileorectal anastomosis (1). The median operating time was 100 min (range 65-180 min). There were two (8%) conversions. The median time to normal diet was 24 h (range 2-192 h) and median hospital stay 3 days (range 1-30 days). Complications, seen in six patients, included atrial fibrillation (2), wound infection (2), ileus (2), CO(2) retention (1), stoma necrosis (1), circulatory collapse/bowel ischaemia (1) and anastomotic leak (1). There was one (4%) readmission and two (8%) returns to theatre. One patient died. Laparoscopic resectional surgery in acute LBO is feasible and safe with a low complication rate that enables early hospital discharge.