title: Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score-Matched Analysis.
abstract: OBJECTIVE
  The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction.
  
  
  METHODS
  Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters.
  
  
  RESULTS
  A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien-Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score-matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score-matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score-matched open adhesiolysis groups (0% vs 4%, p = 0.31).
  
  
  CONCLUSIONS
  Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.
authors.affiliation: 1 Department of Abdominal Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Hackenberg
authors.affiliation: 1 Department of Abdominal Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Mentula
authors.affiliation: 1 Department of Abdominal Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Leppäniemi
authors.affiliation: 1 Department of Abdominal Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.|2 Department of Transplantation and Liver Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: V
authors.initials: V
authors.lastname: Sallinen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D057216:Propensity Score; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
keywords: Laparoscopy; acute abdomen; adhesiolysis; complication; emergency; randomized controlled trial; retrospective; small-bowel obstruction