title: Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes.
abstract: BACKGROUND
  Laparoscopic management of adhesive small bowel obstruction (SBO) has become an established technique within the domain of acute care surgery. As minimally invasive management of SBO becomes more widely accepted, there is increased need for reporting of outcomes.
  
  
  OBJECTIVE
  To compare outcomes of laparoscopic versus open surgery for adhesive SBO.
  
  
  METHODS
  Patients undergoing surgery for adhesive SBO at our institution between 2005 and 2013 were eligible for inclusion. The primary outcome was overall complication rate, while secondary outcomes included operative time, gastrointestinal (GI) function, and postoperative length of stay (LOS). Univariable analysis compared laparoscopic (including conversions) and open groups with regard to patient baseline and perioperative characteristics as well as outcomes of interest. Multivariable analysis was performed comparing the endpoint of overall complications between groups. Sensitivity analysis excluding patients who underwent bowel resection was performed to assess effect on outcomes. Factors associated with laparoscopic success, as well as impact of conversion to open on postoperative outcomes, are reported.
  
  
  RESULTS
  A cohort of 269 patients with adhesive SBO was identified: 186 patients (69.1%) underwent open surgery, 83 (30.9%) were managed laparoscopically. Within the laparoscopy group, 32 (38.6%) underwent conversion to open. Operative time was similar between groups (P = 0.506), while laparoscopy was associated with quicker recovery of GI function indicated by removal of nasogastric tube (P = 0.031) and passage of flatus (P = 0.005). Postoperative LOS was shorter (5 vs. 7 days, P = 0.031) with laparoscopy. The overall complication rate was significantly lower in the laparoscopic group (27.7 vs. 43.6%, P = 0.014), with an adjusted odds ratio (OR) for overall complications of 0.37 (P = 0.002). Following exclusion of bowel resections, secondary outcomes continued to favor laparoscopy, while reduction in overall complications trended toward significance, OR 0.47 (P = 0.050).
  
  
  CONCLUSIONS
  Laparoscopic surgical management of adhesive SBO was associated quicker GI recovery, shorter LOS, and reduced overall complications compared to open surgery.
authors.affiliation: Division of General Surgery, University Health Network, 399 Bathurst Street, 8-MP 325A, Toronto, ON, M5T 2S8, Canada, jpbyrne@gmail.com.
authors.forename: James
authors.initials: J
authors.lastname: Byrne
authors.forename: Fady
authors.initials: F
authors.lastname: Saleh
authors.forename: Luciano
authors.initials: L
authors.lastname: Ambrosini
authors.forename: Fayez
authors.initials: F
authors.lastname: Quereshy
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D061646:Operative Time; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome