title: Risk of adhesive obstruction after colorectal surgery: the benefits of the minimally invasive approach may extend well beyond the perioperative period.
abstract: BACKGROUND
  Risk of adhesive small-bowel obstruction (SBO) is high following open colorectal surgery. Laparoscopic surgery may induce fewer adhesions; however, the translation of this advantage to a reduced rate of bowel obstruction has not been well demonstrated. This study evaluates whether SBO is lower after laparoscopic compared with open colorectal surgery.
  
  
  METHODS
  Patients who underwent laparoscopic abdominal colorectal surgery, without any previous history of open surgery, from 1998 to 2010 were identified from a prospective laparoscopic database. Details regarding occurrence of symptoms of SBO (colicky abdominal pain; nausea and/or vomiting; constipation; abdominal distension not due to infection or gastroenteritis), admissions to hospital with radiological findings confirming SBO, and surgery for obstruction after the laparoscopic colectomy were obtained by contacting patients and mailed questionnaires. Patients undergoing open colorectal surgery for similar operations during the same period and without a history of previous open surgery also were contacted and compared with the laparoscopic group for risk of obstruction.
  
  
  RESULTS
  Information pertaining to SBO was available for 205 patients who underwent an elective laparoscopic procedure and 205 similar open operations. The two groups had similar age, gender, and sufficiently long duration of follow-up. Despite a significantly longer duration of follow-up for the laparoscopic group, admission to hospital for SBO was similar between groups. Patients who underwent laparoscopic surgery also had significantly lower operative intervention for SBO (8% vs. 2%, p = 0.006).
  
  
  CONCLUSIONS
  Although the rate of SBO was similar after laparoscopic and open colorectal surgery, the need for operative intervention for SBO was significantly lower after laparoscopic operations. These findings especially in the context of the longer follow-up for laparoscopic patients suggests that the lower incidence of adhesions expected after laparoscopic surgery likely translates into long-term benefits in terms of reduced SBO.
authors.affiliation: Department of Colorectal Surgery, Desk A30, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. areshef1@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Reshef
authors.forename: T L
authors.initials: TL
authors.lastname: Hull
authors.forename: R P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D003106:Colon / Q000601:surgery; D004380:Duodenal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D007579:Jejunal Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control