Laparoscopic management of acute small bowel obstruction

Bailey, Ian; Rhodes, Michael; O’Rourke, Nick; Nathanson, L. K.; Fielding, George

doi:10.1046/j.1365-2168.1998.00535.x

Cited by 93 publications

(76 citation statements)

References 4 publications

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“…Laparoscopically treated patients had a significantly shorter hospital stay than patients who underwent conversion, as reported also in other studies [2,6,19], leading to lower total hospital costs [2]. In our study, the difference in the length of hospital stay between converted and nonconverted cases was 6 days.…”

Section: Discussionsupporting

confidence: 71%

Laparoscopy for small bowel obstruction: the reason for conversion matters

et al. 2009

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Background Although laparoscopy is associated with reduced hospital stay, early recovery, and decreased morbidity compared with open surgery, it is not well established for the treatment of small bowel obstruction (SBO). Methods This study analyzed a prospective nationwide database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery.Results From 1995 to 2006, 537 patients underwent laparoscopy for SBO. Matted adhesions were the main cause of obstruction (62.6%). Intraoperative complications occurred for 9.5% of the patients. Postoperative morbidity was 14% and mortality 0.6%. Within 30 days, 13 patients (2.4%) were readmitted because of early recurrence or complications. The conversion rate was 32.4%. The conversions resulted from inability to visualize the site of obstruction or matted adhesions (53.4%), intraoperative complications (21.3%), and small target incisions for resection (25.3%). Emergency operations were associated with higher conversion rates (43.6% vs 19.8%; p \ 0.001) but not with significantly more postoperative complications (15.2% vs 11.9%; p = 0.17). Intraoperative complications and conversion were associated with significantly increased postoperative morbidity (39.2% vs 11.3%; p \ 0.001 and 24.7% vs 8.3%; p \ 0.001, respectively). Reactive conversion due to intraoperative complications was associated with the highest postoperative complication rate (48.6%). Morbidity for preemptive conversion due to impaired visualization/matted adhesions or a small-target incision was significantly lower (20% and 26.1%; p = 0.02 and p \ 0.001, respectively). American Society of Anesthesiology (ASA) scores higher than 2 also were associated with postoperative morbidity (p \ 0.001). However, multivariate regression analysis showed that reactive conversion was the only independent risk factor for postoperative morbidity (p \ 0.001; odds ratio, 3.97; 95% confidence interval, 1.83-8.64). Conclusions Laparoscopic management of SBO is feasible with acceptable morbidity and low mortality but with a considerable conversion rate. Early conversion is recommended to reduce postoperative morbidity.Keywords Laparoscopy Á Small bowel obstruction Small bowel obstruction (SBO) after open abdominal surgery may occur for 3% of patients [1]. Surgery is mandatory when conservative management has failed. Although laparoscopy is associated with early recovery, reduced hospital stay, and decreased morbidity compared with open surgery [2], the minimally invasive approach is not yet established for the treatment of SBO. Surgeons still are reluctant to use laparoscopy due to distension of the small bowel, impaired working space, and the risk of iatrogenic small bowel injuries.Several studies have shown the feasibility of laparoscopy for SBO, demonstrating its acceptable morbidity and low recurrence rates. However, most of the series were small or retrospective [3,4], thus hampering the interpretation of the published results.Laparoscopic surgery is not feasible for all patients with SBO. Conversion rates rangin...

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Section: Discussionsupporting

confidence: 71%

Laparoscopy for small bowel obstruction: the reason for conversion matters

et al. 2009

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“…Prior abdominal surgery, which is often performed through a midline laparotomy, leads to adhesions of the small and large bowel to the anterior abdominal wall, and blind insertion may cause inadvertent perforation of the adjacent hollow viscus organs. Dilated bowel loops are a common problem in cases of emergency laparoscopy and cases of adhesion-and cancer-related (peritoneal carcinomatosis) bowel obstruction, so open access is probably safer than blind puncture of the abdominal cavity in these circumstances [1]. As far as we could tell, neither the type, size, or shape of the trocar contributed to an increased risk of perforating lesions.…”

Section: Discussionmentioning

confidence: 70%

Trocar and Veress needle injuries during laparoscopy

Lauper²,

2001

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Background: Inadvertent lesions of the intraabdominal organs and vessels caused by trocars and Veress needles are rare but serious complications of laparoscopic surgery. Establishing the pneumoperitoneum is believed to be the most dangerous step. Methods: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing various standard laparoscopic procedures between 1995 and 1997. This database was investigated with special regard to intraabdominal complications caused by trocars and Veress needles. Results: There were 22 trocar and four needle injuries (incidence, 0.18%). Nineteen lesions involved visceral organs; the remaining seven were vessel injuries. The small bowel was the single most affected organ (six cases), followed by the large bowel and the liver (three cases each). All vascular lesions, except for one laceration of the right iliac artery, occurred as venous bleeding of either the greater omentum or the mesentery. Fourteen trocars were inserted under direct vision. Nineteen trocar injuries were recognized intraoperatively; diagnoses of two small bowel and one bladder injuries were made postoperatively. Needle injuries were all diagnosed intraoperatively. Only five injuries could be repaired laparoscopically; the remaining lesions were repaired openly. Four patients underwent an open reoperation, and another patient needed five reoperations. There was one death (4.0%). Conclusions: Trocar and needle injuries are rare complications of laparoscopy. However, if not recognized intraoperatively and repaired immediately, they induce increased morbidity and mortality. Both open and closed establishment of the pneumoperitoneum are related to a potential danger of perforating lesions, but inserting the first trocar under direct vision allows early recognition and immediate repair.

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“…On the other hand, no perforation or recurrent obstruction was missed in this series. Unplanned reoperations are reported in 6-14 per cent of patients such as these 25,28 . Although intraoperative bowel perforation did not worsen the postoperative course, the incidence during laparoscopic treatment was nearly twice that of conventional open operation, and perforation was significantly more common in patients with two or more previous laparotomies.…”

Section: Discussionmentioning

confidence: 94%

“…In the present study, patients in whom laparoscopic treatment was intended had fewer postoperative complications, quicker recovery of bowel movements and a shorter hospital stay than conventionally treated patients. Bailey et al 28 have also shown a shorter hospital stay after laparoscopic compared with open management of acute SBO. An advantage with regard to bowel movements has been described previously only for laparoscopically treated patients compared with those whose operations for acute SBO were converted 24 .…”

Section: Discussionmentioning

confidence: 95%