Laparoscopic management of acute small bowel obstruction: a retrospective study on 156 patients.
OBJECTIVE
Laparoscopic treatment of small bowel obstruction (SBO) has been proposed in selected patients. This study reports an experience and tries to establish indications for laparoscopy.


METHODS
156 patients underwent laparoscopic or open approach for SBO. Demographics, clinical, biological, radiological and previous surgery were recorded. Obstruction causes, conversion rates and postoperative complications were retrospectively analyzed.


RESULTS
Laparoscopic approach was undertaken for 96 patients (61%) and completed in 62 (65%), whereas 34 (35%) required conversion. 60 patients (39%) underwent a direct open approach. Mortality was 10% and morbidity 38%. Postoperative adhesion was the predominant etiology. Conversion rate and type of approach was directly influenced by cause of obstruction and type of previous surgery, but not by number of previous surgeries. Conversions and open approach increase morbidity, mortality, length of stay and return to transit.


CONCLUSIONS
Laparoscopy is an elegant tool for management of selected patients with SBO. A single band of obstruction appearing after minor surgery appears to be a good indication for laparoscopy. Nevertheless, conversion rate and morbidity are still high. On the contrary, laparoscopy seems contraindicated for patients with prior history of major abdominal surgery, neoplasia or multiple laparotomies, and a direct open approach is then advocated. Prospective randomized studies comparing laparoscopy and open approach are required to evaluate their respective efficacy and safety in management of SBO.
Mathieu
X
X
Department of Digestive Laparoscopic and Thoracic Surgery, C.H.U. Brugmann, U.L.B., Brussels, Belgium.
Thill
V
V
Simoens
Ch
Ch
Smets
D
D
Ngongang
Ch
Ch
Debergh
N
N
da Costa
P Mendes
PM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult