title: Early postoperative small bowel obstruction: open vs laparoscopic.
abstract: BACKGROUND
  The window for safe reoperation in early postoperative (<6 weeks) small bowel obstruction (ESBO) is short and intimately dependent on elapsed time from the initial operation. Laparoscopic procedures create fewer inflammatory changes than open laparotomies. We hypothesize that it is safer to reoperate for ESBO after laparoscopic procedures than open.
  
  
  METHODS
  Review of patients who underwent re-exploration for ESBO from 2003 to 2009 was performed. Based on the initial operation, patients were classified as "open" or "laparoscopic." The Revised Accordion Severity Grading System was used to define complications as minor (1 to 2) or severe (3 to 6).
  
  
  RESULTS
  There were 189 patients identified (age 55 years, 48% male): 130 open and 59 laparoscopic. Adhesive disease was more common (65% vs 42%, P < .01), while strictures were less frequent (5% vs 14% P = .03), in the open group. The open group had a greater rate of malignancy, days to re-exploration, and severity of complications. There was no difference in the rates of minor complications, enterotomy, and mortality. ESBO after laparoscopic surgery was more commonly caused by a focal source (85% vs 63%). Eighty-three patients (64 open, 19 laparoscopic) underwent re-exploration at or beyond 14 days. Within this subgroup, there were more severe complications (25% vs 5%) after open procedures with equivalent mortality (4% vs 0%).
  
  
  CONCLUSIONS
  Laparoscopic approaches confer a lower rate of adhesive disease and severity of complications in early SBO as compared with open surgery even if performed after 2 weeks of index procedure.
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA.
authors.forename: Naeem
authors.initials: N
authors.lastname: Goussous
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Kemp
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bannon
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Srvantstyan
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Khasawneh
authors.affiliation: Department of Surgery, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA. Electronic address: zielinski.martin@mayo.edu.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Laparoscopic surgery; Open surgery; Small bowel obstruction