Acute Adhesive Small Bowel Obstruction Research Articles

Management of rare complications in obese patients after laparoscopic gastric bypass

The complications resulting from laparoscopic gastric bypass can be categorised into two main groups: early (within 30 days after surgery) and late (after 30 days following surgery). Bleeding, marginal ulcers, and failure of the suture line occur most often. Stenosis of the anastomotic areas, adhesive small bowel obstruction, incarceration of Petersen’s space hernia, gastrogastric fistula, and hemobezoar‑induced small bowel obstruction are less often observed. Objective — to improve the management of rare complications in obese patients after laparoscopic gastric bypass. Materials and methods. The study includes a retrospective analysis of patients who underwent laparoscopic gastric bypass in the Department of General Surgery No. 2 at Bogomolets National Medical University from 2011 to 2023. Patients aged 25 to 59 who met the IFSO criteria for obesity participated in the research. The minimum observation period was 12 months. All patients underwent a laparoscopic Roux‑en‑Y Gastric Bypass. Results. The study included a cohort of 348 patients who underwent laparoscopic gastric bypass. The majority of them were female, including 189 individuals (54.3%). A total of 6 patients (1.72%) were identified with rare problems, consisting of 2 women and 4 men. Two patients were diagnosed with acute small bowel obstruction caused by a hemobezoar, one patient with gastrogastric fistula, one patient with acute adhesive small bowel obstruction, one patient with a marginal ulcer of the «large» stomach complicated by perforation, and one patient with a pinched Petersen’s space hernia. All complications were class IIIb, according to the Clavien‑Dindo classification, and required surgical treatment. In the early period, 3 (50%) cases were diagnosed: acute adhesive small bowel obstruction (2 days postoperatively ) and acute small bowel obstruction caused by a hemobezoar (2—3 days postoperatively). Conclusions. We found that the incidence of rare complications among obese individuals after laparoscopic gastric bypass was 1.72%. Specifically, 1.14% of patients experienced small bowel obstruction, 0.29% had a marginal ulcer of the «large» stomach complicated by perforation, and 0.29% had a pinched Petersen’s space hernia. Each case of a rare complication requires an individual approach to its management.

Predicting of intestinal ischemia in patients with adhesive small bowel obstruction

Aim. To detect intestinal ischemia promptly in patients with acute adhesive small bowel obstruction.Methods. A total of 124 patients with acute adhesive small bowel obstruction were studied. Logistic regression analysis was performed to determine the most significant prognostic factors for intestinal ischemia. The derived regression coefficient indicators were utilized in a scoring system.Results. Six independent prognostic factors of intestinal ischemia were identified: age, duration of pain, body temperature, white blood cell count, reduced intestinal wall contrast, and localized mesenteric edema visible on a CT scan. Regression coefficient scores were attributed to each variable associated with intestinal ischemia. The predicted occurrence of bowel ischemia was computed as a sum of scores ranging from 0 to 24. A threshold of 6 points was used to define the low-probability group (risk of bowel ischemia was 1.13%). A score between 7 and 15 determined the intermediate-probability group (the risk of intestinal ischemia was 44%). A score of ≥16 defined the high-probability group (all patients in this group had intestinal ischemia).Conclusions. The risk prediction assessment of bowel ischemia was performed with high accuracy (above 90%). This evaluation is reliable and reproducible, hence it may aid the surgeon to differentiate patients with intestinal ischemia for surgical intervention. Since ischemic disorders may be reversible, this could prevent the development of intestinal necrosis.

The role of computed tomography in the diagnosis of acute adhesive small bowel obstruction

Purpose of the study: to determine the role of multislice computed tomography (MSCT) in the diagnostic algorithm for the management of patients with acute adhesive small bowel obstruction.Materials and methods. The study included 168 patients undergoing inpatient treatment from 2015 to 2019 with a diagnosis of acute small bowel obstruction. The obturation form of acute adhesive small bowel obstruction (AASBO) was detected in 151 patients, while 17 patients have strangulation form of obstruction. The study compared two groups of patients who differ in the examination algorithm:Group I – “traditional” approach – 74 patients who used X-ray (plain radiography, with passage assessment) and ultrasound to diagnose intestinal obstruction.Group II – “proposed” algorithm, included 94 patients whose diagnostic complex, in addition to the methods described above, was supplemented with MSCT with enterography.Results. In the group of "proposed" algorithm, the sensitivity, specificity and accuracy of MSCT was 99.7%, 86.6%, 97.8%, respectively, in the diagnosis of the obturation AASBO, and the resolution of the obstruction was detected significantly earlier than in the "traditional" group (p = 0.0081).Conclusion. Computed tomography is the most accurate method of diagnosing the presence, cause and level of intestinal obstruction; in addition, it is the most effective way to evaluate the efficacy of conservative therapy.

Morphofunctional changes in the small intestine in acute adhesive small bowel obstruction

Aim: To study the features of morpho-functional changes in the small intestine mucosa in acute adhesive small bowel obstruction.Material and methods. The results of a comprehensive study of morphological and functional changes in the small intestine’s mucous membrane in 20 patients out of 50 with acute adhesive small intestinal obstruction were analyzed. Patients underwent resection of the small intestine with a biopsy from the mucous membrane, followed by a pathomorphological and biochemical examination of biopsy specimens.Results. The study results show that more pronounced pathomorphological changes in the mucous membrane of the small intestine were observed in patients with acute adhesive small intestinal obstruction with widespread (multiple) adhesions compared with limited (single) adhesions. In the study of biochemical parameters in the small intestine mucosa in patients with acute adhesive small intestinal obstruction with the presence of multiple (widespread) adhesions, there was a significant and critical increase in lipid peroxidation and proinflammatory cytokines, a decrease in antioxidant protection compared to the patient group with the presence of single (limited) adhesions. There was also a decrease in the concentration of serotonin in the mucosa of the small intestine. In the presence of single (limited) adhesions in these patients, it decreases to 0,50±0,3 units, and in patients with multiple (common) adhesions - to 0,20±0,2 arb. units.Conclusion. The severity of morpho-functional changes in the mucosa of the small intestine directly correlates with the severity of the development of the adhesive process and acute adhesive small bowel obstruction.

Existing Scores Fail to Predict Bowel Ischemia in Patients With Adhesive Small Bowel Obstruction

IntroductionEarly recognition of bowel ischemia is critical in patients suffering from acute adhesive small bowel obstruction (ASBO). Recent studies attempted to propose a score combining clinical and radiological factors to predict the risk of bowel ischemia in patients with ASBO. This study aimed to compare and validate the existing clinical scores with a cohort of surgical patients. MethodsWe conducted a retrospective study including all ASBO cases admitted to our institution between January 1, 2005 and December 31, 2019. Based on three existing clinical scores, we calculated the risk of bowel ischemia for each patient. We then divided the cohort into groups based on the risk for bowel ischemia. For each risk-based category, the proportion of patients who underwent surgical resection and were found to have evidence of ischemic bowel was calculated. ResultsA total of 160 patients presenting with 217 episodes of acute ASBO were included. One hundred seventy-one (78.8%) cases were managed nonoperatively while 46 cases (21.2%) required surgery. Sixteen patients (7.3%) were eventually found to have ischemic bowel while 13 required small bowel resection (5.9%). All three clinical scores showed correlation between the calculated risk of ischemia and the intraoperative finding of ischemia. However, all three scores overestimated ischemia rates in the high-risk groups, yielding a PPV of 8.3%-28.5% and a NPV of 93.3%-94.7%. ConclusionsCurrent clinical scores for predicting bowel ischemia in patients with ASBO are of high value in ruling out ischemia, yet are of extremely low sensitivity, warranting an overly aggressive and unnecessary surgical approach.

Some features of the pathogenetic mechanisms of the development of acute adhesive small bowel obstruction

Aim . To study the pathogenetic mechanisms of the development of acute adhesive small bowel obstruction. Material and methods . An analysis is given of the results of a comprehensive examination of 50 patients with acute adhesive small bowel obstruction. In 46 (92%) observations out of 50 (100%) patients, the causes of acute adhesive small bowel obstruction were various pathologies of the abdominal cavity organs, which had a history of diff erent types of surgery and volume of surgical interventions, and in 4 (8%) cases it was primary, without carrying out surgical interventions. Results . The results of the study showed a signifi cant decrease in the level of serotonin in biopsies of the mucous membrane of the small intestine and in the blood serum with the progression of oxidative stress and cytokine activity in patients with acute adhesive small bowel obstruction, who had a history of various surgical interventions on the abdominal and pelvic organs, and there were also infl ammatory processes in the small intestine. This leads to disruption of the motor function of the small intestine, the development of intestinal paresis. Depending on the extent of the lesion and the occurrence of pathomorphological changes in the walls of the small intestine, single or multiple viscero- visceral and viscero- parietal adhesions are subsequently formed with the development of acute adhesive small bowel obstruction. Conclusion . Thus, in the pathogenesis of acute adhesive small bowel obstruction, the leading place is given to a decrease in the number and qualitative composition of EC-cells of the small intestine mucosa producing serotonin due to oxidative stress and cytokine activity.

Acute Adhesive Small Bowel Obstruction: a Comparative Analysis of Open and Laparoscopic Surgery

Background. Acute adhesive small bowel obstruction (AASBO) is a common surgical emergency requiring immediate interventions. AASBO is a usual indication for both small bowel resection and adhesiolysis. Postoperative adhesions cause 60% of small bowel obstructions.Materials and methods. An analysis of treatment outcomes is presented for 197 acute adhesive small bowel obstruction patients; 63 patients had urgent laparotomy, and 134 were scheduled for laparoscopy. The examination included physical, laboratory, radiological methods (abdominal radiography, ultrasound, CT scan), laparoscopy and intra-abdominal pressure monitoring.Results and discussion. Of 134 patients scheduled for laparoscopic adhesiolysis, only 46.2% had laparoscopy completed, and 53.8% required conversion to laparotomy. The main rationale for conversion were massive adhesions, intraoperative haemodynamic instability, a need for intestinal decompression, as well as rare complications. Laparoscopic operations were reported with the lower vs. laparotomy rates of surgical complications (6.4 vs. 12.69%), mortality (6 vs. 6.3%), shorter hospital stays (6.5 vs. 12 days) and operation times (75 vs. 118 min, respectively).Conclusion. Laparoscopic surgery in acute adhesive small bowel obstruction was feasible in 31.47% patients and in 46.2% — after a diagnostic laparoscopy; however, a thorough patients selection for laparoscopic adhesiolysis is necessary. The first estimated should be the patient’s haemodynamic stability, the severities of condition, adhesions and comorbid cardiorespiratory pathology. Grade I—II adhesions are an indication for laparoscopic surgery.

Nasointestinal intubation in the treatment of acute adhesive small bowel obstruction

Proximal gastrointestinal decompression is essential in the treatment of acute adhesive small bowel obstruction. Improvement of endoscopic methods, surgical instruments and radiological methods of control makes it possible to timely assess lavage and intra-intestinal therapy. The review presents current views on upper gastrointestinal decompression and other options for the treatment of adhesive small bowel obstruction.

New approaches in conservative treatment of acute adhesive small bowel obstruction

To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted nasointestinal drainage of small bowel with injection of a water-soluble contrast. There were 128 patients with acute adhesive small bowel obstruction for the period from 2015 to 2018. The study included 2 groups of patients depending on therapeutic approach and duration of treatment. In the first group, conventional approach for acute adhesive small bowel obstruction was applied. Upon admission, all patients with confirmed acute adhesive small bowel obstruction underwent gastric intubation for decompression of the upper gastrointestinal tract. Barium sulfate injection followed by X-ray examination was performed to assess an effectiveness of therapy. In the second group, computed tomography was performed in addition to X-ray examination and ultrasound. Moreover, conservative treatment included deep endoscopy-assisted nasointestinal drainage and subsequent administration of a water-soluble contrast in addition to traditional approaches. Therapy was effective in 99 (71.2%) patients; 39 (28.8%) ones required surgery. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast was effective in 45 (78.9%) patients. Overall mortality in traditional approach was 1.4%, postoperative mortality - 3.7%. There were no lethal outcomes in case of a new approach. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast is the most effective therapeutic method for acute adhesive small bowel obstruction (78.9%). These findings can significantly improve treatment outcomes in these patients.

Timing of surgery, intestinal ischemia and other real factors of mortality in acute adhesive small bowel obstruction: a multiple-center study

To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO). A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups. ASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (n=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (n=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (p=0.287), early and late surgery in patients with strangulation (p=0.940), early and late surgery in patients without strangulation (p=0.76). Patients died (n=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (n=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, p=0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, p=0.061), bowel resection (95% CI 33.3-14.0, p=0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613). Delayed surgery may be advisable in patients with ASBO and no obvious signs of strangulation due to less mortality.

ОСНОВНЫЕ АСПЕКТЫ СПАЕЧНОЙ ТОНКОКИШЕЧНОЙ НЕПРОХОДИМОСТИ

Immediacy of the problem of acute adhesive small bowel obstruction (AASBO) is due to its high prevalence and presence of certain difficulties in diagnosis, which affect the choice of the treatment method. In addition, the long-term results of treatment cannot be considered satisfactory due to the large number of AASBO recurrences. In 64-93% of cases, adhesions form on the abdominal organs after surgery. It should be noted that their recurrence after open surgery reaches 30% of cases, and after repeated operations this value increases to 78%. Determination of the main etiological factor is of great importance, which makes it possible to assess the feasibility surgery, since it is known that if adhesions do not develop, treatment can be conservative. In this regard, X-ray methods of investigation can be of great help. Surgical intervention is recommended in the presence of intestinal dysfunction symptoms that do not disappear after conservative treatment or when it worsens. Surgical intervention is recommended if symptoms of intestinal dysfunction do not disappear after conservative treatment or if they deteriorate. n recent decades, specialists in the field of abdominal surgery have been striving to expand the indications for laparoscopic interventions in order to reduce the invasiveness of surgery, which will also decrease the risk of adhesions. Keywords: Bowel obstruction, small intestine, surgery, adhesions, laparoscopic adhesiolysis.

SURGICAL APPROACH AT IATROGENIC INJURIES OF EXTRAHEPATIC BILIARY TRACTS

Aim: To study the efficiency of reconstructive operations in “recent” iatrogenic injuries of extrahepatic biliary tracts. Methods. The experiment on surgical treatable of 22 patients with iatrogenic “recent” injuries of extrahepatic biliary tracts is submitted. Primary reparative operation has been performed to 1 patient (suturing of hepaticocholedochus injury after Laparoscopic cholecystectomy). Reparative operations throughout Roux-en-Y biliodigestive anastomosis were performed to 19 patients (Roux-en-Y hepaticojejunostomy - 4, Roux-en-Y bihepaticojejunostomy - 13, Roux-en-Y trihepaticojejunostomy - 2). The external drainage of extrahepatic biliary tracts of the 2nd patient has been the final method of surgical treatable. Results.Post-surgery complaints and mortalities. Among all the 22 patients with iatrogenic injuries of extrahepatic biliary tracts the post-surgery complaints of 4 patients have been registered: failure of stitches of Roux-en-Y bihepaticojejunostomy - 1, acute adhesive small bowel obstruction - 1, stenosis of bihepaticojejunostomy - 1, purulence of surgical wound - 1. Post-surgery mortality is 4,5 %. Conclusion.Roux-en-Y biliodigestive surgery is the main conclusive method in reconstructive treatment of iatrogenic injuries of extrahepatic biliary tracts.

Case of combination of acute intestinal obstruction and acute myocardial infarction

The case of combination of acute myocardial infarction and acute adhesive small bowel obstruction in 70-years old female patient was reported.

The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction

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.

Method of selective resonance stimulation in the treatment of acute adhesive small bowel obstruction.

Aim. Demonstration of the technique of resonant stimulation of peristaltic activity in patients with acute adhesive intestinal obstruction with the aim of correcting enteral insufficiency. Material and methods. The outcome of treatment of 46 patients with adhesive intestinal obstruction (2015-2016) is analyzed. The 1st group (21 patients - prospectively) and the 2nd group (25 patients - retrospectively) are fully commensurable. In the 2nd group - standard therapy. Patients of group 1 for the correction of enteral insufficiency, prevention of progression of intraperitoneal hypertension, stimulation of peristaltic activity, in addition to standard therapy, sessions of resonant stimulation were conducted. Results. By the end of the first session (about 70% of patients), and at the 2 nd session in group 1, responses of all stimulated departments were obtained, with synchronization of sensitivity and preservation of activity in background stimulation regimes. The maximum sensitivity increased to M110 ± 13 mcV. In the course of enterography, the passage to the distal ileum was 6.2 ± 2.1 hours in Group 1 and 8.1 ± 2.3 hours (p≤0.05) in Group 2. By the end of the second day of treatment, by all patients in 1 Group the transvesical-measured pressure was 5.8 ± 1.3 mm Hg, while the mean value of abdominal pressure in group 2 was 10.3 ± 3.9 mm Hg (р≤0,05), and 7 patients showed signs of grade 1 hypertension. Conclusion. These data allow us to look optimistically at the improvement of the results of surgical treatment of acute adhesive intestinal obstruction, avoiding excessive and sometimes vain surgical activity, reducing the risk of further trauma to the peritoneum and the formation of adhesions.

Acute adhesive small-bowel obstruction: laparotomy or laparoscopy

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment. Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders. Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy). Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

Optimal time of surgery for acute adhesive small bowel obstruction

To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

Use of water-soluble contrast medium (gastrografin) does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction? A multicenter, randomized, clinical trial (Adhesive Small Bowel Obstruction Study) and systematic review

This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel obstruction. Between October 2006 and August 2009, 242 patients with uncomplicated acute adhesive small bowel obstruction were included in a randomized, controlled trial (the Adhesive Small Bowel Obstruction Study, NCT00389116) and allocated to a gastrografin arm or a saline solution arm. The primary end point was the need for operative intervention within 48hours of randomization. The secondary end points were the resection rate, the time interval between the initial computed tomography and operative intervention, the time interval between oral refeeding and discharge, risk factors for the failure of nonoperative management, in-hospital mortality, duration of stay, and recurrence or death after discharge. We performed a systematic review of the literature in order to evaluate the relationship between use of gastrografin as a diagnostic/therapeutic measure, the need for operative intervention, and the duration of stay. In the gastrografin and saline solution arms, the rate of operative intervention was 24% and 20%, respectively, the bowel resection rate was 8% and 4%, the time interval between the initial computed tomography and operative intervention, and the time interval between oral refeeding and discharge were similar in the 2 arms. Only age was identified as a potential risk factor for the failure of nonoperative management. The in-hospital mortality was 2.5%, the duration of stay was 3.8days for patients in the gastrografin arm and 3.5days for those in the saline solution arm (P = .19), and the recurrence rate of adhesive small bowel obstruction was 7%. These results and those of 10 published studies suggest that gastrografin did not decrease either the rate of operative intervention (21% in the saline solution arm vs 26% in the gastrografin arm) or the number of days from the initial computed tomography to discharge (3.5 vs 3.5; P = NS for both). The results of the present study and those of our systematic review suggest that gastrografin administration is of no benefit in patients with adhesive small bowel obstruction.

Laparoscopic Intervention for Cases of Adhesive Small Bowel Obstruction: Is It Safe and Beneficial?

Objective: The objective of the study was to evaluate the safety and benefit of laparoscopic management of adhesive small bowel obstruction in order to establish an optimal operative strategy for those patients. Methods: Between April 2012 to September 2014, our study included 56 patients who presented with acute adhesive small bowel obstruction required surgical intervention. We performed laparoscopy for all patients and performed laparoscopic adhesiolysis whenever possible (LAP Group). Otherwise we converted to open surgery (CONV Group) and we compared the outcome of the two groups and evaluated the risk and benefit of initial laparoscopy. Results: 56 patients were enrolled in this study. Laparoscopic techniques (LAP) alone were successfully used to complete 40 cases (73%). Sixteen patients (28%) were converted to open surgery through midline laparotomies. A single band was identified in 38 patients. Complications were comparable between the two groups however the laparoscopic cases benefited from shorter operative times, fewer wound complications (infection/hernia), quicker recovery, shorter hospital stay, and less pain. Conclusion: Laparoscopy has a valuable role for cases presented with adhesive small bowel obstruction, specifically for those patients with a postoperative single band causing obstruction. So, most patients with adhesive intestinal obstruction are candidates for laparoscopy. A significant number of patients will be spared a large laparotomy incision.

Is laparoscopy feasible and effective for acute postoperative small bowel obstruction in Africa ? A case report in Yaoundé, Cameroon

Laparoscopic management of acute adhesive small bowel obstruction has been shown to be feasible and advantageous. However, widespread acceptance and application is still not observed. We describe the case report of a 58-year-old male who presented with signs and symptoms of small bowel obstruction status twenty years after two consecutive open surgeries for complicated acute appendicitis. The patient underwent successfully a laparoscopic band lysis after failure of conservative management. This is the first report of laparoscopic management of adhesive small bowel obstruction in Cameroon. Laparoscopic adhesiolysis of acute adhesive small bowel obstruction is feasible and safe by skilled surgeons in selected patients even in developing countries.