ThTP5.7 Laparoscopic Management of Adhesional Small Bowel Obstruction: Is it Feasible?

Abstract

Abstract Despite advances in laparoscopic surgery, there is limited evidence on its application and outcomes for the management of adhesional small bowel obstruction(aSBO). Literature defines indications for surgery, without addressing the appropriate approach, traditionally involving laparotomy. This study investigated the feasibility of laparoscopic adhesiolysis for aSBO. This retrospective cohort study included electronic data of patients admitted with aSBO, in a large laparoscopic centre over 3 years. Exclusion criteria applied to non-adhesional SBO, large bowel pathology and conservative treatment. Outcomes included the rate and reason for conversion to laparotomy, complications and length of stay (LOS). 85 patients with CT proven aSBO were included, over 3 years. 69(81.2%) of patients were approached laparoscopically and there was a 32%rate of conversion to laparotomy, due to technical difficulty(54.6%), planned “laparoscopy-first”(22.7%) or intraoperative emergency(18.2%).Those managed laparoscopically had 5 days median LOS compared to 9 in the converted subgroup. Operation note review, revealed a standard operative approach using naso-gastric tube, right sided ports, and collapsed small bowel manipulation to identify the adhesion point. Enterotomy rate was 13.0% and 14.5%of patients required bowel resection from an extraction site. Post-operatively, 20.3%of patients suffered prolonged ileus, 5.8%anastomotic leak, 5.8%required re-operation, 8.7%were readmitted with recurrence and there were 10(14.5%) in-hospital deaths. Our study indicated that laparoscopic adhesiolysis could be feasible for selected patients, with a CT proven transition point. Given the observational findings of this single centre study, further research in laparoscopic units is required, including direct comparison with laparotomy, and converted subgroups, aiming to generate standardised guidelines for the laparoscopic management of aSBO.