title: Laparoscopic versus open adhesiolysis for small bowel obstruction - a multicenter, prospective, randomized, controlled trial.
abstract: BACKGROUND
  Laparoscopic adhesiolysis is emerging as an alternative for open surgery in adhesive small bowel obstruction. Retrospective studies suggest that laparoscopic approach shortens hospital stay and reduces complications in these patients. However, no prospective, randomized, controlled trials comparing laparoscopy to open surgery have been published.
  
  
  METHODS
  This is a multicenter, prospective, open label, randomized, controlled trial comparing laparoscopic adhesiolysis to open surgery in patients with computed-tomography diagnosed adhesive small bowel obstruction that is not resolving with conservative management. The primary study endpoint is the length of postoperative hospital stay in days.Sample size was estimated based on preliminary retrospective cohort, which suggested that 102 patients would provide 80% power to detect a difference of 2.5 days in the length of postoperative hospital stay with significance level of 0.05. Secondary endpoints include passage of stool, commencement of enteral nutrition, 30-day mortality, complications, postoperative pain, and the length of sick leave. Tertiary endpoints consist of the rate of ventral hernia and the recurrence of small bowel obstruction during long-term follow-up. Long-term follow-up by letter or telephone interview will take place at 1, 5, and 10 years.
  
  
  CONCLUSIONS
  To the best of our knowledge, this trial is the first one aiming to provide level Ib evidence to assess the use of laparoscopy in the treatment of adhesive small bowel obstruction.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01867528. Date of registration May 26th 2013.
authors.affiliation: Department of Abdominal Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 Helsinki, Finland. ville.sallinen@helsinki.fi.
authors.forename: Ville
authors.initials: V
authors.lastname: Sallinen
authors.forename: Heidi
authors.initials: H
authors.lastname: Wikström
authors.forename: Mikael
authors.initials: M
authors.lastname: Victorzon
authors.forename: Paulina
authors.initials: P
authors.lastname: Salminen
authors.forename: Vesa
authors.initials: V
authors.lastname: Koivukangas
authors.forename: Eija
authors.initials: E
authors.lastname: Haukijärvi
authors.forename: Berndt
authors.initials: B
authors.lastname: Enholm
authors.forename: Ari
authors.initials: A
authors.lastname: Leppäniemi
authors.forename: Panu
authors.initials: P
authors.lastname: Mentula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult