Feasibility of laparoscopy for small bowel obstruction.
BACKGROUND
Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity.


METHODS
We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources.


RESULTS
The feasibility of diagnostic laparoscopy is high (60-100%), while that of therapeutic laparoscopy is low (40-88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies </= 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon.


CONCLUSIONS
Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.
Farinella
Eriberto
E
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Cirocchi
Roberto
R
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
La Mura
Francesco
F
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Morelli
Umberto
U
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Cattorini
Lorenzo
L
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Delmonaco
Pamela
P
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Migliaccio
Carla
C
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
De Sol
Angelo A
AA
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Cozzaglio
Luca
L
Department of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.
Sciannameo
Francesco
F
Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.