title: Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias.
abstract: BACKGROUND
  Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO).
  
  
  METHODS
  From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required.
  
  
  RESULTS
  The mean age of the 33 patients who underwent surgery was 61.1 ± 17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83 ± 44 min. and 7.8 ± 11.2 days, respectively. Operative time (72 ± 30 vs 123 ± 63 min.), tolerance to oral intake (1.8 ± 0.9 vs 5.7 ± 3.3 days) and length of postoperative stay (4.7 ± 2.5 vs 19.4 ± 21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group.
  
  
  CONCLUSIONS
  In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short hospital length of stay and low morbidity); its use would be fully justified in these cases.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: ipoves@parcdesalutmar.cat.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Poves
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Enric
authors.initials: E
authors.lastname: Sebastián Valverde
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Sònia
authors.initials: S
authors.lastname: Puig Companyó
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Dorcaratto
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Estela
authors.initials: E
authors.lastname: Membrilla
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: María José
authors.initials: MJ
authors.lastname: Pons
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: Luís
authors.initials: L
authors.lastname: Grande
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006547:Hernia / Q000150:complications*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000150:complications*
keywords: Adherencias inducidas por cirugía; Adherencias quirúrgicas; Adhesiolisis; Adhesiolysis; Intestinal obstruction; Laparoscopia; Laparoscopy; Obstrucción intestinal; Postoperative adhesions; Surgery induced tissue adhesions