Laparoscopic approach to postoperative adhesive obstruction.
BACKGROUND
Some authors have assessed the feasibility of laparoscopy in the treatment of postoperative adhesive obstruction, but conclusions about its effectiveness are related to different selection criteria used for surgery. This paper reports on our experience in laparoscopic adhesiolysis and analyses the results on the basis of the selection criteria used.


METHODS
From January 1993 to December 2001, 65 patients were submitted to laparoscopic adhesiolysis for small bowel obstruction according to specific selection criteria. Of the 65 patients, 40 were admitted for acute obstruction and 25 for chronic or recurrent transit disturbances. Correlation between historical and clinical data and the results of surgical treatment were statistically analyzed.


RESULTS
The procedure was completed by laparoscopy in 52 patients (conversion rate: 20%). Mean postoperative stay was 4.4 days with a 12.3% morbidity and no mortality. Recurrence rate was 15.4%; a single correlation was found between recurrence and age.


CONCLUSIONS
Laparoscopic adhesiolysis in the treatment of small bowel obstructions seems to be effective; further studies are required to define selection criteria for surgery and confirm real advantages in terms of recurrences.
Borzellino
G
G
I Divisione Clinicizzata di Chirurgia Generale, Università di Verona, Italia. joeborz@iol.it
Tasselli
S
S
Zerman
G
G
Pedrazzani
C
C
Manzoni
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography