Abstract
BackgroundPostoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity.MethodsA retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO.Results262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38.5%. Patients in the laparoscopic group were younger (p < 0.001), had fewer previous abdominal operations (p = 0.001), lower ASA grade (p < 0.001), and less complex adhesions were found (p = 0.001). Operative time was longer in the open group (p = 0.004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67.9%, p < 0.001), lower mortality (p = 0.026), earlier oral intake (p < 0.001) and shorter hospital stay (p < 0.001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2.89; 95% CI 1.1–7.6; p = 0.033).ConclusionsLaparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.
Highlights
Postoperative adhesions represent 75% of all acute small bowel obstructions
The aim of our study is to evaluate the impact of the laparoscopic approach on postoperative outcomes in our series of patients consecutively operated for adhesive small bowel obstruction (ASBO)
About 50% of all the ASBO were caused by complex adhesions, single bands and/or internal hernias predominated in the laparoscopy group and complex bands in the open group. 21% of the patients required intestinal resection, which was more frequent in open group (p = 0.014)
Summary
Postoperative adhesions represent 75% of all acute small bowel obstructions. Open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity. Postoperative adhesions are the most common cause of acute small bowel obstruction, representing 75% of all cases. In Sebastian-Valverde et al BMC Surgery (2019) 19:40 the guides of the World Society of Emergency Surgery Adhesive Small Bowel Obstruction working group [9, 10], only factors related to pneumoperitoneum (hemodynamic instability or cardiopulmonary impairment) are considered absolute exclusion criteria for laparoscopic approach.
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