Early Bowel Obstruction Research Articles

Rare events model of the MBSAQIP database: risk of early bowel obstruction following metabolic surgery

BackgroundEarly small bowel obstruction (eSBO) (within 30-days) is a rare but important complication that is associated with high rates of morbidity, including readmission, reintervention, and reoperation. ObjectivesTo identify patient-specific and operation-specific characteristics that predispose patients to eSBO and to identify at-risk individuals preoperatively. Setting2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). MethodsUtilizing the 2015-2021 MBSAQIP PUF, 1,016,484 records were analyzed. Pediatric, revisional, open-conversion, and cases with incomplete data in sex, body mass index, operative-time, 30-day-follow-up variables were excluded. Case details were compared using Fisher’s exact & Wilcoxon -Mann -Whitney tests to identify at-risk patients. The likelihood of eSBO was modeled with rare event logistic regression. ResultsIncidence of eSBO was .40%. Of the 4103 occurrences of eSBO, RYGB (Roux-en-Y gastric bypass), SG (sleeve gastrectomy), and DS (duodenal switch) accounted for 79.4%, 19.3%, and 1.3%, respectively. Many patient-specific characteristics were significantly associated with eSBO. History of prior foregut surgery, a non-metabolic surgery trained operator, and longer operative times were all associated with increased eSBO (P < .0001). While simultaneously controlling for these factors, eSBO remained higher in DS (OR 9.55, P < .0001) and RYGB (OR 5.18, P < .0001) compared to SG. Increased length of operation (OR 1.03, P < .0001) and non -MS-trained operators (OR 1.33, P < .0001) remained highly significant. Male-sex (OR .70, P < .0001) and diabetes (OR .78, P < .0001) were both protective. ConclusionsIn the largest analysis to date, eSBO remains a rare event. RYGB accounts for the largest proportion of eSBO, however, DS has a higher risk adjusted rate of eSBO.

Early Bowel Obstruction after Bariatric Surgery: An Analysis of the 2020-2021 MBSAQIP Database.

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program evaluates 30-day outcomes of bariatric cases performed in the United States. The Participant Use File in 2020 introduced bowel obstruction (BO). We compared the rates of BO, risk factors, and postoperative outcomes after laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and duodenal switch (DS). Retrospective analysis of patients who underwent laparoscopic RYGB, SG, or DS obtained from the 2020-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Patients who underwent either as a primary procedure with a body mass index >35kg/m2 were selected. Baseline characteristics, operative details, and postoperative complications were collected. The outcome of interest was BO occurring within 30 days. A total of 205,533 cases of which 148,944 were SG (72.4%), 54,606 were RYGB (26.5%), and 1983 were DS (1%). BO occurred in 0.74%, 0.4%, and 0.03% of patients who underwent an RYGB, DS, or SG, respectively. Patients with a BO in the RYGB group were more likely to be on immunosuppressive therapy (5.4% vs. 1.9%, P<0.001) with longer operative time (136.2min±58.0min vs. 117.4min±53.6min, P<0.001). SG patients with a BO were older (47.5±13.6 vs. 41.9±11.6, P=0.011) with longer operating times (98.6±63.8 vs. 68.9±33.4, P=0.002). Patients in the RYGB group with a BO had the highest rates of readmissions (71.9%) and reoperations (58.4%). Early bowel obstruction is rare after bariatric surgery. It is more common after RYGB and least common after SG. Readmission and reoperation rates were highest in patients with BO in the RYGB group.

Efficacy of Daikenchuto in the prevention of bowel obstruction in patients with colorectal cancer undergoing laparoscopic surgery: An observational study using a Japanese administrative claims database.

Daikenchuto is an herbal medicine widely used in Japan without clear evidence to prevent bowel obstruction after abdominal surgery. We evaluated the efficacy of Daikenchuto in laparoscopic surgery for colorectal cancer (CRC). We included patients from the medical claims databases diagnosed with CRC between January 2012 and December 2019 and treated with laparoscopic surgery. We compared the Daikenchuto and control groups to evaluate early bowel obstruction (EBO) events for 1year. The Daikenchuto group included patients prescribed Daikenchuto on postoperative day (POD) 0 or 1. An EBO event was defined as the use of a nasogastric tube, transnasal ileus tube, endoscopic balloon dilatation, or the requirement of reoperation for bowel obstruction from PODs 1 to 364. In total, 46,458 patients met the eligibility criteria; 2407 and 44,051 patients were included in the Daikenchuto and control groups, respectively. Some of the patient's characteristics were significantly different between the groups. The frequencies of EBO events in the Daikenchuto and control groups were 5.7% (95% confidence interval: 4.8-6.7) and 4.6% (4.4-4.8), respectively. The most frequent events were nasogastric tube (3.1%, 2.9%) and transnasal ileus tube insertions (1.4%, 0.8%) in the Daikenchuto and control groups, respectively. The hospital stay was significantly shorter in the Daikenchuto group than in the control; this trend was confirmed in the sensitivity analysis. Daikenchuto did not demonstrate efficacy for EBO. It might be adequate for shortening patient's hospital stay. Further studies are warranted.

The Omental Plug: A Novel Management Approach of Concomitant Ventral Hernias During Bariatric Surgery.

Severe obesity leads to a higher incidence of ventral hernias, thus complicating up to 8% of bariatric procedures. The optimal management of these hernias continues to be a controversial topic. We present our novel approach of utilizing an omental plug for concomitant ventral hernia management during metabolic surgery. To prevent early bowel incarceration and obstruction during bariatric surgery, we sutured the omentum circumferentially to the edges of the hernia defect and to the hernia sac itself with absorbable suture. Four patients were managed with this novel omental plug technique. All patients were female. The mean age was 53 years (range 39 to 68 y), the mean body-mass index was 54.75 kg/m 2 (range 49 to 59 kg/m 2 ), and the mean follow-up was 4.6 months (range 1.5 to 6.5 mo). There were no hernia-related complications through the follow-up period. The omental plug technique is a feasible, inexpensive, and safe alternative for ventral hernias with the potential prevention of bowel incarceration during bariatric surgery. This approach allows deferring the definitive hernia repair for a later stage.

Computed Tomography Image Segmentation of the Proximal Colon by U-Net for the Clinical Study of Somatostatin Combined with Intestinal Obstruction Catheter.

Objective U-Net technology is implemented for image segmentation to diagnose cases of intestinal obstruction. To evaluate the application value of somatostatin combined with transanal intestinal obstruction decompression catheter in the treatment of distal colonic malignant intestinal obstruction and to explore the therapeutic effect of somatostatin on acute abdomen surgery in patients with intestinal obstruction. Methods After the segmentation technique, a retrospective analysis of 30 patients with acute and complete distal colonic malignant obstruction treated by surgery was divided into a control group and an observation group according to a random number table. The treatment efficiency, clinical symptoms, disappearance time after treatment, and the incidence of complications were compared between the two groups of patients. Results The image segmentation using U-Net can effectively assist in the medical diagnosis of the colon. Our study found that patients with combined treatment with somatostatin and anal intestinal obstruction catheter were relieved of preoperative abdominal pain and abdominal distension; compared with the abdominal circumference at the time of admission, the abdominal circumference was significantly reduced. Abdominal examination was performed 3 days after comprehensive treatment, and combined with computed tomography (CT), we observed that the measured maximum transverse diameter of the proximal colon was significantly smaller than that before treatment. Before treatment, all patients were divided into a control group and a treatment group. After treatment, the symptoms of the two groups of patients were alleviated. The treatment effective rate of the observation group was 93.3%, and the treatment effective rate of the control group was 73.3%. The effective rate was significantly higher than that of the control group, and the difference was statistically significant. Conclusions Through the use of image segmentation technology, somatostatin treatment of early inflammatory bowel obstruction after acute abdomen surgery can effectively improve the treatment efficiency of patients, shorten the disappearance of clinical symptoms, reduce the incidence of complications, and have a significant therapeutic effect, which is worthy of clinical application. Somatostatin combined with enteral obstruction catheter treatment is safe and effective for elderly patients with acute distal large bowel malignant intestinal obstruction. It has a higher completion rate of laparoscopic surgery and a first-stage anastomosis power, which reduces the risk of perioperative period and reduces the patient's financial burden.

Reoperations in the treatment of acute appendicitis in children

Aim – to assess the experience in the treatment for children with postoperative abdominal complications after acute appendicitis, to determine their incidence rates and types, to analyze reasons of their occurrence with the view of effective prevention.Material and methods. Treatment results of 8832 various aged children, who underwent urgent surgery for acute appendicitis in 2009–2018, were analyzed. Results of surgical treatment in 204 (2.31 %) children with postoperative abdominal complications, who had to be reoperated, were presented. In total, 216 reinterventions were performed. Complete examination of the patients included clinical, laboratory and instrumental methods.Results. Continuing peritonitis in 94 patients (46.07 % of cases) and peritonitis with secondary purulent-septic complications (intraabdominal abscesses, intestinal perforations, purulent omentitis, intestinal suture failure, complications of Meckel’s diverticulum) in 58 patients (28.43 % cases) were the main reasons of relaprotomies. Early adhesive bowel obstruction was a reason for relaparotomies in 52 patients (25.49 % cases). 167 relaparotomies were performed on-demand, including 101 open relaparotomies and 66 laparoscopic. 49 of relaparotomies were programmed and performed in 37 children: 36 open programmed laparotomies and 13 programmed laparoscopeis. One child died postoperatively of severe sepsis with polyorganic dysfunction.Conclusions. Patient’s age, general condition, premorbid state and duration of the disease should be taken into account in urgent appendectomies that significantly influence the surgical results and allow predicting treatment outcomes. Children under the age of 3 years are included in the risk group of possible postoperative complications. There were 22.06 % of complications in this patient group. More than 2/3 of patients were admitted late to the surgical department – more than 24 hours after the onset of the disease. Postoperative complications in children occur most frequently in destructive types of appendicitis and late hospitalization. Continuing peritonitis (46.08 %), abscesses of abdominal cavity (15.20 %), intestinal obstruction (25.49 %) were the main surgical indications for relaparotomy. Laparoscopic relaparotomy (in total, 79 operations, including 66 (83.54 %) on-demand and 13 (16.46 %) programmed) is an adequate method for postoperative abdominal complications allowing to achieve positive treatment results in overwhelming majority of patients. Integrated treatment for children with severe generalized peritonitis postoperative peritonitis can benefit from programmed therapeutic relaparotomy.

Patterns and surgical outcome of neonatal small bowel obstruction: a single center experience from Ujjain, India

Background: Neonatal small bowel obstruction is the most commonly encountered paediatric surgical emergency worldwide and in India. The objective of this study was to study the prevalence and spectrum of neonatal small bowel obstruction.Methods: A retrospective chart review of all neonates aged between 1-28 days that underwent surgery for small intestinal obstruction between January 2017 to January 2019 at Department of Paediatric Surgery, R.D. Gardi Medical College, Ujjain, MP. A predesigned questionnaire was used to collect demographic, clinical and outcome related information. Exploratory laparotomy and type of surgical intervention was done as per the cause.Results: A total of 52 neonates (M: F ratio 1.74: 1) were included in the study. The most common clinical features were vomiting (92%), bilious vomiting (85%) and abdominal fullness (75%) and laboratory feature was leucocytosis (42%) and thrombocytopenia (31%). Most (66%) neonates presented between 2-7 days and belonged to rural areas (65%). The two most common final diagnosis were malrotation (56%) and intestinal atresia (23%). Associated anomalies were seen in 29% [vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities association (8%) and congenital heart disease (8%)]. The mean (±SD) duration to reach full feeds and duration of neonatal intensive care unit stay was 6.2±1.3 and 14.1 (±5) days, respectively. Complications were seen in 20% cases, most common being early bowel obstruction. A total of 6 (11.5%) neonates died in the post-operative period, 83% because of sepsis.Conclusions: Small bowel obstruction is common neonatal surgical emergency. Most common cause is malrotation and intestinal atresia. Neonatal sepsis is the most common underlying cause of death post-operatively.

Recognition of the diagnosis and treatment of small intestinal obstruction

Small intestinal obstruction is a common and frequent disease in general surgery. Delayed diagnosis and surgical timing, and inaccurate treatment strategy will lead to life-threatening complications. Therefore, how to diagnose and treat quickly and accurately is still a difficult problem in current gastrointestinal surgery. This paper summarizes and analyzes the diagnosis and treatment strategies of small intestinal obstruction based on current laboratory technology, medical imaging technology, perioperative management and improvement of surgical concepts. At the same time, early postoperative inflammatory small bowel obstruction, radioactive enteritis with intestinal obstruction, primary abdominal cocoon, primary pseudo obstruction are discussed according to the long-term experience of the author's department. The aim is to establish a reasonable and effective strategy for the diagnosis and treatment of common and special small intestinal obstruction.

Urinary Diversion With vs Without Bowel Anastomosis in Patients With an Existing Colostomy: A Multi-institutional Study

To describe the short-term outcomes with the bowel anastomosis (BA) approach vs the no-bowel anastomosis (NBA) approach in adult patients undergoing urinary diversion. A chart review was performed of adults undergoing urinary diversion from 2006 to 2015. Patients with a pre-existing colostomy were divided into NBA and BA groups. Postoperative complications were recorded per the Clavien-Dindo system. Variables were compared using the BA group as a control. A 2-tailed t test was used to compare means. A total of 43 patients were included: 33 in the BA group and 10 in the NBA. No significant differences were found between the 2 groups for the comorbidity index (P = .16), the body mass index (P = .54), or radiation history (P = .90). In the NBA and BA groups, the median blood loss was 250 and 300 mL (P = .11); the operative time was 550 and 480 minutes (P = .15); and the length of stay was 10 and 25 days (P = .38), respectively. The BA group had a higher rate of intraoperative (P = .04) and early (P = .02) overall complications. No significant difference was found in early bowel (P = .15) or ureteral obstruction (P = .08), in the overall stomal complications (P = .11), or in the rate of <90-day reoperation (P = .32). A lower rate of intraoperative and postoperative complications occurred in patients undergoing conversion of colostomy to a urinary diversion compared with patients with de novo urinary conduit creation. When possible, a BA should be avoided.

Early endoscopic management for early bowel obstruction after gastrectomy: a case report.

BackgroundEarly bowel obstruction is not a rare complication of gastrectomy, and it may require re-operation in some cases.Case presentationWe report the case of a 71-year-old woman who underwent a total gastrectomy with Roux-en-Y reconstruction for a massive gastrointestinal stromal tumor. Postoperatively, she was making good progress and started consuming meals on postoperative day 3. However, on postoperative day 10, she complained of upper abdominal discomfort and nausea. Blood tests showed a mild inflammatory reaction. An upper gastrointestinal series showed obstruction of the elevated jejunum. An abdominal computed tomography scan suggested upper bowel obstruction. Endoscopic observation and repositioning was selected as an effective approach for treatment considering the patient’s clinical condition and background. Upper gastrointestinal endoscopy showed kinking of the elevated jejunum, easy passage through to the anal intestine, and no evidence of mucosal edema, stenosis of the Roux-en-Y anastomosis, bowel ischemia, or necrosis. After endoscopic repositioning, upper gastrointestinal series showed good passage of the jejunum and no evidence of bowel obstruction. At the 6-month follow-up examination, the patient was in good condition and had no complaints.ConclusionWe concluded that early endoscopic management should be the effective procedure considered for diagnosis and treatment of early bowel obstruction after gastrectomy in some cases.

Early Postoperative Small Bowel Obstruction associated with the use of V-loc™ Sutures during Surgery for Pelvic Organ Prolapse

Aims: To describe three cases of early postoperative bowel obstruction after use of barbed suture material during surgery for pelvic organ prolapse (POP). Introduction: The utilization of minimally invasive surgical techniques for the treatment of POP is increasing, with a subsequent increase in the use of barbed, self-anchoring suture material, such as the V-locTM suture, which facilitates intracorporeal suturing. Case report: We present three cases of early postoperative small bowel obstruction related to the use of barbed sutures during minimally invasive surgery for POP, as well as a review of the relevant literature. Conclusion: Surgeons should use barbed suture material judiciously and should have a high index of suspicion for barbedsuture related mechanical obstructions. These obstructions are not likely to resolve with conservative management. Clinical significance: Barbed suture materials allow for ease of laparoscopic suturing but carry a risk of contributing to early bowel obstruction. Laparoscopic surgeons should be aware of this relatively unknown potential complication.

Staple line as a cause of unusual early internal hernia after appendectomy

The use of mechanical stapling devices in laparoscopic appendectomies has become a common practice. Occasionally, the retained staples have been described to cause adhesions that might result in bowel obstruction. Early bowel obstruction after routine abdominal surgery should be closely investigated and might warrant early re-exploration. We present a rare case of small bowel obstruction caused by a staple line adhesive band one week after appendectomy.A 46-year-old female underwent laparoscopic appendectomy for uncomplicated appendicitis. A linear endoscopic stapling device was utilized during the procedure. The patient was discharged without complication. One week later, the patient presented to the emergency room for abdominal pain and she was discharged after adequate pain control. Several hours later she returned with similar symptoms, and she was diagnosed with distal small bowel obstruction by computed tomography scan. During the diagnostic laparoscopy there was an internal hernia through a defect created by the appendiceal staple line and the adjacent small bowel mesentery. After reduction of the hernia, the small bowel venous drainage improved, and no intestinal resection was necessary. The offending staple was removed and the staple line covered with omentum.The patient had complete resolution of symptoms and she was discharged the following day. No perioperative complications occurred.Mechanical staplers are routinely used in laparoscopic appendectomy.The staple line should be inspected at the end of the procedure to confirm the absence of free, unformed staples that can generate adhesions and postoperative complications.

Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction

To evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO). Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy. In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction. For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.

Diagnosis and treatrment of 68 patients with early postoperative inflammatory small bowel obstruction

Objective To investigate the clinical features of early postoperative inflammtory small bowel obstruction,and discuss its diagnosis,treatment and preventive measures.Methods The clinical data of 68 cases of early postoperative inflammatory small bowel obstruction were analyzed retrospectively.Results Within the 68 cases,65 cases were cured by non-operative treatment including gastrointestinal decompression,anti-inflammatory drugs,somatostatin,total parenteral nutrition(TPN) and traditional Chinese medicine.The mean time from the onset of symptoms to the recovery of bowel function was 14 days.Three cases were cured by transferring to operation.One case of them was transferred to operation for strangulated intestinal obstruction during the period of conservative treatment.One case underwent oper.ion because the patient didn t recover after 4 weeks expectant treatment.One case underwent operation for the impatience with the conservative treatment of both the doctors and the patient.Conclusion Non-operative therapy should be the first choice for the treatment of early postoperative inflammatory small bowel obstruction,and its therapeutical effect was well-accepted. Key words: Intestinal pseudo-obstruction; Digestive system surgical procedures/adverse effects; Intubation; gastrointestinal

Predictive Factors of Early Bowel Obstruction in Colon and Rectal Surgery: Data from the Nationwide Inpatient Sample, 2006–2008

Early postoperative bowel obstruction is associated with considerable morbidity and mortality after colorectal surgery. We evaluated the impact of patient characteristics, patient comorbidities, pathology, resection site, surgical technique, admission type, and teaching hospital status on the incidence of in-hospital bowel obstruction after colorectal surgery. Using the Nationwide Inpatient Sample database, we examined the clinical data of patients who underwent colorectal resection from 2006 to 2008. Regression analyses were performed to identify factors predictive of in-hospital bowel obstruction. A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of postoperative bowel obstruction was 8.65% (elective surgery: 5.32% vs emergent surgery: 13.26%; p < 0.01). Bowel obstruction was less frequent after laparoscopic procedures compared with open procedures (6.61% vs 8.81%; p < 0.01). Using multivariate regression analysis, Crohn disease (adjusted odds ratio [AOR] = 12.32), emergent surgery (AOR = 2.54), malignant tumor (AOR = 1.84), diverticulitis (AOR = 1.45), age older than 65 years (AOR = 1.22), female sex (AOR = 1.14), history of alcohol abuse (AOR = 1.12), transverse colectomy (AOR = 1.11), peripheral vascular disease (AOR = 1.07), left colectomy (AOR = 1.06), chronic lung disease (AOR = 1.05), open procedure (AOR = 1.05), African-American race (AOR = 1.03), and teaching hospital (AOR = 1.02) were associated with a higher risk of in-hospital bowel obstruction. There was no association between hypertension, diabetes, congestive heart failure, chronic renal failure, liver disease, obesity, smoking, proctectomy or total colectomy, and early bowel obstruction. Early bowel obstruction is a relatively common complication after colorectal surgery. Crohn disease patients had a 12-fold higher incidence of early bowel obstruction, and emergent surgery and malignancy were relevant predictors of early bowel obstruction.

Predictive factors of early bowel obstruction in colon and rectal surgery: Data from the Nationwide Inpatient Sample (NIS), 2006-2008

Predictive factors of early bowel obstruction in colon and rectal surgery: Data from the Nationwide Inpatient Sample (NIS), 2006-2008

Clinical analysis of 22 cases with early postoperative inflammatory small bowel obstruction

Objective To investigate the principles of diagnosis and treatment of early postoperative inflammatory small bowel obstruction(EPISBO).Methods The clinical data of 22 patients admitted to our hospital from January 2000 to June 2009 were analysed for early postoperative inflammatory small bowel obstruction.Results 22 cases were cured in a mean period of 15 days through gastrointestinal decompression,somatostatin,TPN and other medications.There was no reoperations.Conclusion For EPISBO,conservative treatment should be adopted first,somatostatin and TPN has batter results. Key words: Iuleslinal obstruction; Inflammation; Fady Diagnosis; Treatment outcome

Male Patients Above Age 60 have as Good Outcomes as Male Patients 50–59 Years Old at 1-Year Follow-up After Bariatric Surgery

It is estimated that 25% of Americans older than 60 years are obese. Male gender and advanced age are indicators of increased risk for bariatric surgery. Good results have been shown in patients older than 50, but nearly all published studies include a large majority of females, and few include patients >60 years old. In this study, we examined the results of males over 60 years old. We reviewed a prospective database of 107 consecutive patients who underwent bariatric surgery between April 2002 and June 2007 at the Palo Alto VA. Of these, 60 patients were males older than 50 and available for follow-up 12 months postoperatively. There were 47 males 50-59 years old (group I) and 13 males older than 60 years (group II). Data were analyzed using Student's t test. Mean preoperative body mass index was similar in both groups (49.4 vs. 47.5 kg/m(2); p = 0.468). Length of hospital stay was similar (3.2 vs. 3.5 days; p = 0.678), but early morbidity was higher in group II patients (30.8% vs. 8.5%; p = 0.037). Morbidity included urinary tract infection, cardiac arrhythmias, and early bowel obstruction. Excess weight loss after 1 year was not significantly different (63.6% vs. 60.6%; p = 0.565). Diabetes resolution or improvement was seen in 87% of group I patients and 90% of group II patients. Despite a higher early morbidity rate, obese males >/=60 years old perform as well as male patients 50-59 years old with respect to excess weight loss, mortality, length of stay, and improvement of diabetes, at 1 year postoperatively.

Preperitoneal herniation and bowel obstruction post laparoscopic inguinal hernia repair: case report and review of the literature

Laparoscopic inguinal hernia repairs, both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP), are associated with peritoneal defects or tears. Nonclosure of the tears can lead to bowel obstruction. I present a case of an early (48 h) bowel obstruction related to a peritoneal defect post TAPP inguinal hernia repair. The literature on peritoneal closure and bowel obstruction related to laparoscopic inguinal hernia repair is reviewed as well as options for repairing defects.

Clinical analysis of early postoperative inflammatory small bowel obstruction

目的 探讨术后早期炎性肠梗阻的诊断和治疗措施.方法 回顾性分析我院1996年1月至2006年1月收治的61例术后早期炎性肠梗阻患者的临床资料.结果 54例患者经保守治疗痊愈,平均住院时间10.2 d.7例手术治疗后痊愈,其中4例因保守治疗时出现绞窄性肠梗阻而手术,3例保守治疗40 d无效而手术.结论 术后早期炎性肠梗阻应以保守治疗为主,胃肠外营养及生长抑素的应用具有较佳的疗效。