Effect of Laparoscopy on the Risk of Small-Bowel Obstruction

Abstract

To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures. Design: A population-based retrospective register study. Setting: Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated. Patients: The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected. Main Outcome Measures: Episodes of hospital stay and surgery for SBO within 5 years after the index surgery. Results: A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures. Conclusions: Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance.

Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

“…The findings of this study are similar to those in other reports4 15. One15 of these studies reported that after 10 years the need for further operation for adhesive SBO was 7 per cent (5 of 74 patients) following open rectal resection versus 0 per cent (0 of 74) after laparoscopic surgery.…”

“…One15 of these studies reported that after 10 years the need for further operation for adhesive SBO was 7 per cent (5 of 74 patients) following open rectal resection versus 0 per cent (0 of 74) after laparoscopic surgery. The other report4 examined the risk of surgery for SBO including adhesive SBO following rectal resection in a Swedish population‐based study. Among 3523 patients undergoing anterior resection, the 5‐year risk of SBO or adhesive SBO after open anterior resection was 2·8 per cent, compared with 1·6 per cent after laparoscopic surgery.…”

“…Some studies4 7, 8, 9, 10 have suggested an advantage for laparoscopic surgery, whereas others11, 12, 13, 14 have found no difference in the risk of adhesive SBO after open or laparoscopic surgery. Only two studies4 15 have compared the risk of surgery for adhesive SBO following laparoscopic or open rectal surgery. Both suggested an advantage for laparoscopic surgery.…”

“…Adhesions develop after abdominal surgery as a result of peritoneal trauma and subsequent inflammation2. Among patients undergoing abdominal surgery, those with a rectal resection have the highest adhesion‐related readmission rates1 3, 4, and adhesiolysis‐related procedures are associated with high inpatient expenditure5.…”

Minimally Invasive Surgical Techniques for Cancers of the Small Intestine

“…The potential advantages of the minimally invasive approach to small intestinal neoplasm resection include comparable surgical and oncologic outcomes [ 3 , 25 , 26 ], decreased length of stay [ 25 -28 ], cosmetically appealing scar, and improved pain scores [ 24 , 28 -31 ]. In addition, when compared with open operations there is a decrease in incisional hernia occurrence, diminished adhesion formation with a presumed lower postoperative bowel obstruction incidence [ 32 ]. All of these advantages should translate to improved patient satisfaction with a decrease in overall health care costs [ 30 ].…”