Laparoscopic approach to postoperative adhesive obstruction

Borzellino, Giuseppe; Tasselli, Sebastiano; G, Zerman; Pedrazzani, Corrado; Manzoni, Giovanni De

doi:10.1007/s00464-003-9106-9

Cited by 52 publications

(8 citation statements)

References 15 publications

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“…Accordingly, the conversion rate has been reported to be from 6.2% to 52%. 8 , 15 , 24 – 27 Our conversion rates were 13% in the SILS group and 19% in the multiport group. Although forceps movement is restricted by a single-port, the conversion rate of the either group was not significant different.…”

Section: Discussionmentioning

confidence: 67%

“…However, more frequent complications have been shown to occur after converted surgeries than after completed laparoscopic procedures for treatment of ileus. 15 , 25 It has been shown in a previous study that patients in whom a laparoscopic procedure was intended had fewer postoperative complications. Furthermore, laparoscopic treatments carry some advantages, including quicker bowel function recovery and a shorter hospital stay, than conventional approach.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus

Okamoto

Maruyama

Wakana³

et al. 2016

Medicine

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A single incisional laparoscopic surgery (SILS) approach is increasingly being used, taking advantage of the minimally invasive technique. The aim of this study was to evaluate the feasibility and the validation of SILS procedure for small bowel obstruction (SBO).Sixteen consecutive patients with SBO who underwent SILS release of ileus between April 2010 and March 2015 were compared with the conventional multiport laparoscopic treatment group of 16 patients matched for age, gender, and surgical procedure.Laparoscopic treatment was completed in a total of 14 patients in SILS group and 13 in multiport laparoscopic group. Two cases and 3 cases were converted to multiport laparoscopic surgery or open surgery. Eight patients with nonscar and nonadhesive ileus, such as internal hernia, obturator hernia, gallstone ileus, and intestinal invagination, were treated successfully in the laparoscopic procedure. There was no mortality in either of the groups. The mean procedural time was 105 minutes in the SILS group and 116 minutes in the multiport laparoscopic group. The mean amount of blood loss was not statistically different in either of groups (15 ml vs. 23 ml). Patients resumed oral intake after a mean of 2 days in the SILS and 3 days in the multiport groups with the statistically difference. The length of hospital stay was shorter in the SILS group (5 days vs. 7 days) with no statistically difference. Perioperative morbidity was seen in 2 patients in the SILS group and 3 patients in the multiport group.SILS approach has superior and/or similar perioperative outcomes to multiport approach for SBO. SILS release of ileus as an ultra-minimal invasion technique is feasible, effective, and offers benefits with cosmesis in simple adhesive or scar-less nonadhesive ileus patients.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus

Okamoto

Maruyama

Wakana³

et al. 2016

Medicine

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“…In another report of 65 patients submitted to laparoscopic adhesiolysis (40 for acute obstruction and 25 for chronic or recurrent transit disturbances) the procedure was completed by laparoscopy in 52 patients (conversion rate: 20%) and after a mean follow up of 48 months has been observed a 15.4% rate of symptomatic recurrences, while surgical recurrences have been 4.6% [132]. …”

Section: Resultsmentioning

confidence: 99%

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

et al. 2011

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BackgroundThere is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications.MethodsA panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus.RecommendationsIn absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment.Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.

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“…Conversion rates range from 7 to 43% [ 48 ]. Proactive reasons to convert include poor visualization, non-viable intestine, multiple dense adhesions, deep pelvic adhesions, and failure to progress within a reasonable amount of time [ 50 ].…”

Section: Complication Managementmentioning

confidence: 99%

Management of Complications Following Emergency and Elective Surgery for Diverticulitis

Holmer

Kreis

2015

Visc Med

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Background: The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure. Methods: The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature. Results: To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates. Conclusion: The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field.

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Laparoscopic approach to postoperative adhesive obstruction

Abstract: Laparoscopic adhesiolysis in the treatment of small bowel obstructions seems to be effective; further studies are required to define selection criteria for surgery and confirm real advantages in terms of recurrences.

Cited by 52 publications

References 15 publications

Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus

Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

Management of Complications Following Emergency and Elective Surgery for Diverticulitis

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