Elective laparoscopy in diagnosis and treatment of recurrent small bowel obstruction.
BACKGROUND
To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction.


METHODS
Retrospective analysis of 253 patients who underwent therapeutic laparoscopy for recurrent small bowel obstruction from June 1996 to May 2005 was carried out. Patients with acute small bowel obstruction, bowel obstruction due to tumor, and obstructed inguinal hernias were excluded from analysis.


RESULTS
Laparoscopy diagnosed cause of obstruction in all except 3 (1.18%) patients. The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%). One hundred sixty nine patients were managed totally laparoscopically with adhesiolysis. Therapeutic bowel intervention other than adhesiolysis was required in 84 patients, of which 33 procedures were performed totally laparoscopically and remaining 51 procedures were completed with laparoscopically guided target incision. Five patients required conversion to open celiotomy. Iatrogenic enterotomies occurred in 3 patients and small bowel perforation during manipulation occurred in 1 patient. Postoperative procedure-related complications were seen in 44 patients. There was one mortality due to postoperative arrhythmia and cardiac failure.


CONCLUSIONS
Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases.
Chowbey
Pradeep K
PK
Minimal Access and Bariatric Surgery Center, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
Panse
Rashmi
R
Sharma
Anil
A
Khullar
Rajesh
R
Soni
Vandana
V
Baijal
Manish
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000601:surgery; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis / Q000601:surgery