title: Laparoscopic management of acute small-bowel obstruction.
abstract: 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.
authors.affiliation: Department of Surgery, Section of Laparoscopic Surgery, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
authors.forename: I M
authors.initials: IM
authors.lastname: Ibrahim
authors.forename: F
authors.initials: F
authors.lastname: Wolodiger
authors.forename: B
authors.initials: B
authors.lastname: Sussman
authors.forename: M
authors.initials: M
authors.lastname: Kahn
authors.forename: F
authors.initials: F
authors.lastname: Silvestri
authors.forename: A
authors.initials: A
authors.lastname: Sabar
mesh_terms: 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