Laparoscopy for acute small bowel obstruction: indication or contraindication?
BACKGROUND
Acute small bowel obstruction (SBO) is a relatively common cause of emergency hospital admission, most frequently due to postoperative adhesions. With increased experience and technical advances in laparoscopic surgery, the laparoscopic management of acute SBO has become feasible and potentially superior to the open approach. This retrospective study presents the authors' experience with laparoscopic treatment of SBO over a 6-year period to assess the feasibility, efficacy, and clinical outcome of this therapeutic method and to present the author's methodology.


METHODS
From April 2003 to January 2009, 32 patients hospitalized in the author's department for acute SBO underwent elective laparoscopic treatment after failure of conservative measures. Standard laparoscopic techniques and instruments were used.


RESULTS
Postoperative adhesions were identified in 62.5% of patients (n=20) as well as tumor (n=3), incarcerated ventral hernia (n=4), incarcerated femoral hernia (n=3), internal hernia (n=1), and Crohn's disease (n=1). The conversion rate was 18.7% (n=6), and the postoperative complication rate was 3.25% (n=1). The mean operative time was 78 min. Bowel function returned after a mean of 3.2 days, and the mean hospital stay was 4.6 days.


CONCLUSIONS
The laparoscopic treatment of acute SBO is an attractive alternative to the open approach. However, it must be kept in mind that surgery longer than 120 min is a significant predictor of postoperative morbidity, that bowel injury may be missed at the time of operation and can be avoided with improved surgical techniques and appropriate instrumentation, that lysis of all intraabdominal adhesions is unnecessary, and that a low threshold for conversion should be maintained, especially in cases of severe, dense, extensive adhesions.
Tierris
Ioannis
I
Department of Surgery, Henry Dunant Hospital, 107, Mesogeion Avenue, 115 26, Athens, Greece. johntierris@hotmail.com
Mavrantonis
Constantinos
C
Stratoulias
Constantinos
C
Panousis
George
G
Mpetsou
Afrodite
A
Kalochristianakis
Nicolaos
N
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D000075202:Contraindications; D004638:Emergency Treatment / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed