Laparoscopic Management Of Small Bowel Obstruction Research Articles

Laparoscopic Management of Acute Small Bowel Obstruction in Non-Selected Patients: A 10-Year Experience.

The laparoscopic approach to the management of small bowel obstruction (SBO) has been associated with reduced length of hospital stay, complications, and mortality. The laparoscopy-first approach has been limited to highly selective cases to date. In this retrospective observational study, we report our 10-year experience and outcomes within a dedicated Emergency Surgery unit that adopted a non-selective approach in the laparoscopic management of SBO. The surgical approach to all patients that underwent surgery for SBO by an experienced Emergency Surgeon, over a period of 10 years, was divided into two groups of open surgery (OS) or laparoscopy-first (LF). Outcomes included length of stay, complications, mortality, readmission rates and reasons for conversion. Data were reviewed to identify patterns of learning. A total of 189 patients were included in the study. A total of 81.5% were managed with an LF approach. Of these, 25.3% required conversion. LF patients had a similar length of stay, lower 30-day readmission rates and wound complications. Reasons for conversion included need for bowel resection, perforation, and malignancy. Our study had a high intention-to-treat LF population and identified major indications for conversion. As our laparoscopic experience increased, conversion rates substantially reduced. We propose that a LF approach is feasible and can benefit from training within dedicated Emergency Surgery teams.

Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database.

Small-bowel obstruction (SBO) is a common disorder and constitutes a significant healthcare burden. Laparoscopic lysis of adhesions (LLOA) for SBO is predicted to decrease complications, shorten hospital stay, and cut healthcare costs compared with the open lysis of adhesions (OLOA); however, large comparison studies are lacking.We evaluated the nationwide adoption of LLOA and compared outcomes with OLOA. We retrospectively analyzed data from 9920 OLOA and 3269 LLOA cases from 2005 to 2013 using the American College of Surgeons prospective National Surgical Quality Improvement Program data set. Annual trends were evaluated using linear regression.Surgery outcomes were compared using two-sample t tests or Mann-Whitney tests. Post-surgical complications were compared using multivariable logistic regression adjusting for comorbidities. The proportion of SBO cases treated by LLOA increased nationwide by 1.6 percent per year (R 2 0.87), from 17.2% in 2006 to 28.7% in 2013. Patients undergoing OLOA had longer operations (66 vs 60min, P<0.001), longer hospital stay (8.9 vs 4.2days, P<0.001), and higher post-surgical complication rates (adjusted odds ratio 2.73 95% CI 2.36-3.15, P<0.001) when compared to LLOA. Despite the lack of prospective randomized trials comparing LLOA to OLOA, we found progressive nationwide adoption of LLOA for SBO treatment. Our large retrospective analysis demonstrated clinical benefit and reduced resource utilization for LLOA.

Laparoscopy for small bowel obstruction: the reason for conversion matters

Although laparoscopy is associated with reduced hospital stay, early recovery, and decreased morbidity compared with open surgery, it is not well established for the treatment of small bowel obstruction (SBO). This study analyzed a prospective nationwide database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. From 1995 to 2006, 537 patients underwent laparoscopy for SBO. Matted adhesions were the main cause of obstruction (62.6%). Intraoperative complications occurred for 9.5% of the patients. Postoperative morbidity was 14% and mortality 0.6%. Within 30 days, 13 patients (2.4%) were readmitted because of early recurrence or complications. The conversion rate was 32.4%. The conversions resulted from inability to visualize the site of obstruction or matted adhesions (53.4%), intraoperative complications (21.3%), and small target incisions for resection (25.3%). Emergency operations were associated with higher conversion rates (43.6% vs 19.8%; p < 0.001) but not with significantly more postoperative complications (15.2% vs 11.9%; p = 0.17). Intraoperative complications and conversion were associated with significantly increased postoperative morbidity (39.2% vs 11.3%; p < 0.001 and 24.7% vs 8.3%; p < 0.001, respectively). Reactive conversion due to intraoperative complications was associated with the highest postoperative complication rate (48.6%). Morbidity for preemptive conversion due to impaired visualization/matted adhesions or a small-target incision was significantly lower (20% and 26.1%; p = 0.02 and p < 0.001, respectively). American Society of Anesthesiology (ASA) scores higher than 2 also were associated with postoperative morbidity (p < 0.001). However, multivariate regression analysis showed that reactive conversion was the only independent risk factor for postoperative morbidity (p < 0.001; odds ratio, 3.97; 95% confidence interval, 1.83-8.64). Laparoscopic management of SBO is feasible with acceptable morbidity and low mortality but with a considerable conversion rate. Early conversion is recommended to reduce postoperative morbidity.

The laparoscopic management of small-bowel obstruction

Background Small-bowel obstruction (SBO) is a common cause of hospital admission. Our objectives were to determine outcomes of laparoscopic adhesiolysis and outline clinical parameters for its utilization. Methods We reviewed medical records of patients with SBO undergoing initial laparoscopic treatment by the authors between July 1997 and March 2006. Data obtained included demographics, clinical and radiologic presentation, intraoperative outcomes, and postoperative course. Results Forty-two patients were included for analysis. The mean age was 54.3 years, whereas the mean body mass index was 29.5 (range 20.2–46.1). Laparoscopy diagnosed the site of obstruction in all patients. Thirty-five patients (83.3%) were successfully treated laparoscopically without conversion to laparotomy. The median procedural time was lower in patients completed laparoscopically (96.3 vs 207.3 minutes, P = .006). The median postoperative stay was 6.5 days (range 1–19) in patients who were completed laparoscopically. Conclusions Laparoscopy is safe and feasible in the management of acute SBO in selected patients. It is an excellent diagnostic tool and therapeutic in most cases.