Laparoscopic approach compared with conventional open approach for bezoar-induced small-bowel obstruction.
BACKGROUND
Bezoar-induced small-bowel obstruction (SBO) is an uncommon surgical emergency. Accurate preoperative diagnosis is notoriously difficult, and conventional management often necessitates laparotomy. Recent articles demonstrate the feasibility of laparoscopy in the management of SBO. This study compares the outcomes of a series of cases managed laparoscopically with the outcomes of matched open cases.


OBJECTIVE
Laparoscopic management of bezoar-induced SBO is safe and effective when compared with traditional laparotomy treatment.


METHODS
A retrospective study was conducted from November 1, 1998, to November 30, 2003, to compare laparoscopic vs open treatment for bezoar-induced SBO. Patients' demographics, operative details, and surgical outcomes were evaluated.


RESULTS
During the study period, 24 patients (16 men and 8 women) with a mean age of 68.2 years underwent operative treatments for bezoar-induced SBO. Ten patients received laparoscopic treatments and the other 14 received laparotomy treatments. The patients were comparable in age, sex, and physiological status. There were 3 conversions in the laparoscopy group owing to technical difficulties. The laparoscopic approach was associated with statistically significant shorter operative time (P = .048), fewer postoperative complications (P = .04), and reduced hospital stay (P = .009).


CONCLUSIONS
When expertise is available, laparoscopy is safe and effective in the management of bezoar-induced SBO and is associated with superior postoperative outcomes when compared with the conventional open approach.
Yau
Kwok Kay
KK
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, ROC.
Siu
Wing Tai
WT
Law
Bonita Ka Bo
BK
Cheung
Hester Yui Shan
HY
Ha
Joe Ping Yiu
JP
Li
Michael Ka Wah
MK
D000368:Aged; D000369:Aged, 80 and over; D001630:Bezoars / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome