Laparoscopic management of acute small bowel obstruction.
BACKGROUND
As minimally invasive surgery gains ground, it is entering realms previously considered to be relative contraindications for laparoscopy. We reviewed our experience with the laparoscopic approach to the management of small bowel obstruction (SBO).


METHODS
From December 1997 to November 2002, 65 patients underwent laparoscopic treatment for SBO. The operating surgeon attempted to identify a transitional point between distended and collapsed bowel and then address the obstruction at that point.


RESULTS
Postoperative adhesions were the cause of the obstruction in 44 patients. Tumor was identified in five cases, hernia in four, bezoar in three, intussusception in three, acute appendicitis and pseudoobstruction in two cases each, and terminal ileitis in one case. The diagnostic accuracy of laparoscopy was 96.9%. Thirty-four patients (52%) were treated by laparoscopy alone. Thirteen patients (20%) required a small target incision for segmental resection. Eighteen operations were converted to formal laparotomy. The mean laparoscopy time was 40 min (range, 25-160). Patients resumed oral intake in 1-3 days. The complication rate was 6.4%. There were two deaths, but none related to laparoscopy. The mean hospital stay was 4.2 days.


CONCLUSIONS
Laparoscopy is a useful minimally invasive technique for the management of acute SBO. It is an excellent diagnostic tool and, in most cases, a therapeutic surgical approach in patients with SBO. However, a significant number of patients will require conversion.
Kirshtein
B
B
Department of Surgery A, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, 84101, Israel. borkirsh@bgumail.bgu.ac.il
Roy-Shapira
A
A
Lantsberg
L
L
Avinoach
E
E
Mizrahi
S
S
D000006:Abdomen, Acute / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D001630:Bezoars; D004630:Emergencies; D005260:Female; D006547:Hernia / Q000150:complications; D059685:Herniorrhaphy; D017052:Hospital Mortality; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007418:Intestinal Pseudo-Obstruction / Q000175:diagnosis / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery*; D007443:Intussusception / Q000601:surgery; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome