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Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital


Grafen, F C; Neuhaus, V; Schöb, O; Turina, M (2010). Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbeck's Archives of Surgery, 395(1):57-63.

Abstract

PURPOSE: The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery. MATERIALS AND METHODS: Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients). RESULTS: Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique. CONCLUSIONS: A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.

Abstract

PURPOSE: The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery. MATERIALS AND METHODS: Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients). RESULTS: Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique. CONCLUSIONS: A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.

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30 citations in Web of Science®
30 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2010
Deposited On:14 Feb 2010 13:47
Last Modified:07 Dec 2017 00:35
Publisher:Springer
ISSN:1435-2443
Publisher DOI:https://doi.org/10.1007/s00423-009-0490-z
PubMed ID:19330347

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