Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital.
OBJECTIVE
The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery.


METHODS
Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients).


RESULTS
Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique.


CONCLUSIONS
A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.
Grafen
Franziska Carmen
FC
Department of Surgery, Limmattal Hospital, Urdorferstr. 100, CH-8952, Schlieren, Zürich, Switzerland.
Neuhaus
Valentin
V
Schöb
Othmar
O
Turina
Matthias
M