Laparoscopic treatment for small intestinal bleeding: a report of 77 cases.
BACKGROUND
Morbidity of small intestinal disease is rare and the associated lesion is hard to be detected due to lack of specific manifestations and effective diagnostic approaches. Hematochezia and melena are the most common symptoms in small intestinal diseases. Hence, small intestinal disease is an important differential diagnosis when hematochezia or melena occurs, especially when gastric and colonic diseases are excluded. As the small intestinal lesion is hard to be located preoperatively, laparotomy used to be performed without a preoperative location. This might lead to related postoperative complications. With the development of laparoscopic technique, laparoscopic operations are more frequently applied to surgical disease, despite their benign or malignant nature. Generally, almost all kinds of small intestinal disease can be treated with laparoscopic surgery.


METHODS
Clinical data of 77 patients with small intestinal bleeding undergoing laparoscopic or laparoscopy-assisted operations from April 2003 to December 2008 were included, and their clinical information were analyzed retrospectively.


RESULTS
No intraoperative complication or conversion was observed in all cases. The mean operative time, mean estimated blood loss, and mean size of incision were 78.3 +/- 30.5 minutes, 17.5 +/- 9.8 mL, and 3.3 +/- 1.9 cm, respectively. Postoperative complications occurred in 4 patients, including 2 cases of adhesive ileus, 1 case of gastric retention, and 1 case of anastomotic bleeding. All of them were cured by nonoperative management. The mean flatus time was 2 days after operation and the mean postoperative hospital stay was 7 days. There was 1 case of gastrointestinal stromal tumor with local recurrence and hepatic metastasis. Four patients died from metastasis of malignant tumors during the follow-up from 2 to 70 months after operations. No trocar site or wound recurrences were noted.


CONCLUSIONS
Laparoscopic treatment in small intestinal bleeding is feasible, safe, and minimally invasive. It may be widely used in the future for its good therapeutic outcomes and improved diagnostic chance in small intestinal bleeding diseases.
Zang
Lu
L
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
Hu
Wei-Guo
WG
Yan
Xiao-Wei
XW
Zhang
Tao
T
Ma
Jun-Jun
JJ
Ye
Qing
Q
Feng
Bo
B
Wang
Ming-Liang
ML
Lu
Ai-Guo
AG
Li
Jian-Wen
JW
Zhong
Jie
J
Zheng
Min-Hua
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis; D007421:Intestine, Small; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008551:Melena / Q000175:diagnosis; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome