Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis.
BACKGROUND
The objective of this study was to evaluate whether surgical outcomes differ between laparoscopy versus the open approach for adhesive small bowel obstruction.


METHODS
PubMed, MEDLINE, Embase, and the Cochrane Library databases were electronically searched from 1985 to 2010. The study pooled the effects of outcomes of a total of 334 patients enrolled into 4 retrospective comparative studies using meta-analytic methods.


RESULTS
Laparoscopic adhesiolysis was associated with a reduced overall complication rate (odds ratio = .42, .25-.70, P < .01), prolonged ileus rate (odds ratio = .28, .10-.73, P = .01) and pulmonary complication rate (odds ratio = .20, .04-.94, P = .04) compared with the open approach. No significant differences were noted for intraoperative injury to bowel rates (odds ratio = 1.93, .76-4.89, P = .17), wound infection rates (odds ratio = .44, .17-1.12, P = .08), and mortality (odds ratio = .81, .12-5.49, P = .83).


CONCLUSIONS
Laparoscopic adhesiolysis is advantageous in most of the analyzed outcomes. Laparoscopic treatment of small bowel obstruction is recommended by experienced laparoscopic surgeons in selected patients.
Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China 510080.
Ming-Zhe
MZ
Li
Lei
L
Lian
Long-bin
LB
Xiao
Wen-hui
WH
Wu
Yu-long
YL
He
Xin-ming
XM
Song
D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D000267:Tissue Adhesions / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome