title: Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis.
abstract: BACKGROUND
  Adhesional small bowel obstruction (SBO) occurs in 14-17% of patients within 2 years of open colorectal or general surgery. The aim of this pooled analysis is to compare the safety and efficacy of laparoscopic versus open treatment of SBO.
  
  
  METHODS
  An electronic search of Embase, Medline, Web of Science, and Cochrane databases was performed. Weighted mean differences (WMDs) were calculated for the effect size of laparoscopic surgery on continuous variables, and pooled odds ratios (PORs) were calculated for discrete variables.
  
  
  RESULTS
  There were eleven non-randomized comparative studies included this review. Laparoscopic surgery was associated with a significant reduction in mortality (POR = 0.31; 95% CI 0.16-0.61; P = 0.0008), overall morbidity (POR = 0.34; 95 % CI 0.27-0.78; P < 0.0001), pneumonia (POR = 0.31; 95% CI 0.20-0.49; P < 0.0001), wound infection (POR = 0.29; 95% CI 0.12-0.70; P = 0.005), and length of hospital stay (WMD = -7.11; 95 % CI -8.47 to -5.75; P < 0.0001). The rates of bowel injury and reoperation were not significantly different between the two groups. Operative time was significantly longer in the laparoscopic group (WMD = 72.31; 95% CI 60.96-83.67; P < 0.0001).
  
  
  CONCLUSIONS
  Laparoscopic surgery for treatment of adhesional SBO improves clinical outcomes and can be performed safely in selected cases with similar rates of bowel injury and reoperation to open surgery. Large scale randomized controlled trials are needed to validate the findings of this pooled analysis of non-randomized data.
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK. t.wiggins@imperial.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Wiggins
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.affiliation: Department of Laparoscopic and Upper Gastro-Intestinal Surgery, Hinchingbrooke Healthcare NHS Trust, Huntingdon, UK. adrianharris@nhs.net.
authors.forename: Adrian
authors.initials: A
authors.lastname: Harris
mesh_terms: D000208:Acute Disease; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D016017:Odds Ratio; D061646:Operative Time; D012086:Reoperation / Q000706:statistics & numerical data; D000267:Tissue Adhesions / Q000209:etiology / Q000401:mortality / Q000601:surgery*
keywords: Adhesiolysis; Intestinal obstruction; Laparoscopic surgery
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