Laparoscopic management of acute small bowel obstruction.
BACKGROUND
Conventional surgical management of acute small bowel obstruction involves laparotomy. The laparoscopic approach has not been favoured due to the presumed increased risk of bowel injury.


METHODS
A retrospective review of our experience of laparoscopic management of acute small bowel obstruction was undertaken. Nine patients were identified from 1997 to 2003. The aetiology of obstruction was identified laparoscopically in all cases. Eight cases were caused by bands or local adhesions and one patient had a bezoar.


RESULTS
Laparoscopic treatment was successful in 78% of patients including one laparoscopy-assisted procedure. Conversion to laparotomy was performed in two patients, one due to difficult adhesiolysis and one due to iatrogenic bowel injury during adhesiolysis. The mean operating time was 74 minutes. There were no postoperative complications and the mean length of hospital stay was 4.3 days.


CONCLUSIONS
This small series demonstrates that laparoscopy can serve as a good diagnostic tool as well as treatment of acute small bowel obstruction. In an appropriately selected patient, laparoscopic management of small bowel obstruction is a feasible therapeutic approach and appears to convey the benefits of a short postoperative hospital stay, reduced postoperative complications and possibly reduced subsequent adhesion formation.
Liauw
Jennifer J Y
JJ
Minimally Invasive Surgical Centre, National University Hospital, Singapore.
Cheah
Wei-Keat
WK
D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012846:Singapore; D015996:Survival Rate; D016896:Treatment Outcome