Laparoscopic management of acute small-bowel obstruction.
BACKGROUND
A retrospective review is given of the authors' experience with a consecutive series of acute small-bowel obstruction unresponsive to medical management.


METHODS
There were 33 exploratory laparoscopies. The etiology was accurately diagnosed in 100% of the cases. Twenty-five (76%) were secondary to postoperative adhesions, of which 18 (72%) were successfully treated by laparoscopic lysis of adhesions. Minilaparotomy was needed to treat iatrogenic perforation (two), gangrenous bowel (one), and Meckel's diverticulectomy (one). Formal laparotomy was utilized for small-bowel resection (two), malignant adhesions (two), and intolerance of pneumoperitoneum (one). Four cases of incarcerated hernias were treated by conventional herniorrhaphy.


RESULTS
Overall, 67% of our cases were spared formal laparotomy.


CONCLUSIONS
We conclude that laparoscopy is an excellent diagnostic modality in acute small-bowel obstruction, the majority of which can be simultaneously managed laparoscopically. Laparotomy should be reserved for malignant adhesions, surgical misadventure, or when the pathology dictates.
Ibrahim
I M
IM
Department of Surgery, Section of Laparoscopic Surgery, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
Wolodiger
F
F
Sussman
B
B
Kahn
M
M
Silvestri
F
F
Sabar
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies