Adhesive Small Bowel Obstruction in the Minimally Invasive Era

Abstract

Roughly 60% of all cases of small bowel obstruction are caused by adhesions. Adhesions are a form of internal scar tissue, which develop in over 45–93% of patients who undergo abdominal surgery. With this relatively high incidence, the population at risk for adhesive small bowel obstruction (ASBO) is enormous. Minimally invasive surgery reduces surgical wound surface and thus holds promise to reduce adhesion formation. The use of minimally invasive techniques results in a 50% reduction of adhesion formation as compared to open surgery. However, since ASBO can be caused by just a single adhesive band, it is uncertain whether a reduction in adhesion formation will also lead to a proportional decrease in the incidence of ASBO. Minimally invasive surgery might also improve operative treatment of ASBO, accelerating gastro-intestinal recovery time and lowering the risk of recurrent ASBO associated with adhesion reformation. We will discuss recent evidence on the impact of minimally invasive surgery on the incidence of ASBO and the role of minimally invasive surgery to resolve ASBO. Finally, we will debate additional measures, such as the use of adhesion barriers, to prevent adhesion formation and adhesion-related morbidity in the minimally invasive era.

Adhesiolysis during Hysterectomy

“…The most common cause of postoperative small-bowel obstruction is adhesions [12]. The incidence of small bowel obstruction is 2-3 percent in the first year after surgery in all patients who undergo abdominal or pelvic surgery [13].…”

Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions

“…Common complications associated with postsurgical adhesions include small bowel obstruction, chronic pelvic pain, dyspareunia, infertility, and a higher risk of adhesion formation in subsequent surgical operations 1,8–11 . Despite improvements in surgical technique, such as the development of minimally invasive surgery, which reduces tissue trauma and external contamination; adhesions still occur in up to 45%–64% of abdominal operations 1,2,9,12 …”

“…1,[8][9][10][11] Despite improvements in surgical technique, such as the development of minimally invasive surgery, which reduces tissue trauma and external contamination; adhesions still occur in up to 45%-64% of abdominal operations. 1,2,9,12 It has been postulated that postsurgical adhesions are triggered by tissue trauma or injury, and other contributory factors during the procedure, such as sharp, mechanical, or thermal irritation; ischemia; abrasion; and exposure to foreign bodies such as fiber, powder, irritating fluids, and airflow causing oxidative stress. 10,13 Additionally, it was observed in 1919 that healing of the peritoneum is different from external wound healing.…”