Laparoscopic management of acute small bowel obstruction

Kirshtein, Boris; Roy-Shapira, Aviel; Lantsberg, Leonid; Avinoach, Eliezer; Mizrahi, Shlomo

doi:10.1007/s00464-004-9038-z

Cited by 122 publications

(71 citation statements)

References 15 publications

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“…Different conversion rates may partly explain the diverging figures on morbidity in the surgical literature because conversion has been repeatedly identified as a risk factor for postoperative morbidity [5,6,11,14,[16][17][18]. Consistent with these reports, conversion was significantly associated with increased morbidity in our study.…”

Section: Discussionsupporting

confidence: 82%

“…However, surgeons still are reluctant to use the laparoscopic approach in the setting of SBO because of the reduced working space and the risk of iatrogenic lesions, both due to bowel distention. Conversion rates are substantial, ranging from 15% to 52% [5,6,[11][12][13], and morbidity rates are 0% to 47% [5,6,[13][14][15][16]. However, most of these results are based on small retrospective, single-center studies, hampering a comprehensive evaluation of the data.…”

Section: Discussionmentioning

confidence: 99%

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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: 82%

Section: Discussionmentioning

confidence: 99%

Laparoscopy for small bowel obstruction: the reason for conversion matters

et al. 2009

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“…As observed by Suh et al (17) , the main site of intestinal obstruction in our study was the small bowel (58.8%), followed by the colon (37%). Like other authors (1,4,8,11,13) , intestinal adhesions were the main cause of intestinal obstruction in our series, with 43% of cases. Unlike in developed countries and certain regions of Africa, where respectively hernia and volvulus of the colon represent the second leading cause of intestinal obstruction (1,9) , we observed high proportion of cancer incidence.…”

Section: Discussionsupporting

confidence: 86%

“…Recently, the increasing of surgeons' experience and the development of new technologies have made possible the laparoscopic approach in patients with previously contraindication to laparoscopy (11,19) . The introduction of mechanical suturing staplers, forceps more delicate and less damaging to the bowel loops and new instruments for hemostasis contribute significantly to increase the safety and efficacy of laparoscopy in different clinical situations (16) .…”

Section: Discussionmentioning

confidence: 99%

Analysis of the videolaparoscopy potentiality in the surgical treatment of the bowel obstruction

Ghezzi

Moschetti

Corleta

et al. 2010

Arq. Gastroenterol.

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-Context -Laparotomy is the gold standard treatment of patients with intestinal obstruction without response to clinical management. Nowadays, literature has been demonstrating the feasibility of videolaparoscopy in the treatment of intestinal obstruction. Objectives -To report the clinical-epidemiological profile of patients with intestinal obstruction submitted to surgery and verify the presence of contraindications for laparoscopy. Methods -It was done a observational, descriptive and retrospective study including adults patients with intestinal obstruction submitted to surgery at Hospital de Clínicas de Porto Alegre, RS, Brazil, between January of 2004 and October of 2008. Results -It was included 135 patients in the study, with a total of 126 patients submitted to open surgery and 9 to laparoscopy. There was similar distribution between gender and the mean age was 59 years (SD ± 16.9). The most frequent site of obstruction was the small bowel and the most frequent etiology was adhesions. Among the patients submitted to laparotomy, 75.4% presented with abdominal distention, 68.3% previous abdominal surgery, 11.9% body mass index >30 kg/m 2 , 4.8% coagulopathy and 3.2% hemodynamic instability. Among the 135 patients, only 5 of them presented with none contraindications for videolaparoscopy. Conclusion -The epidemiological findings of this study are similar to the ones of the worldwide literature. Indications of videolaparoscopy in retrospective analyses have the limitation of subjective evaluation of intestinal obstruction, which was included in this study as a relative contraindication to laparoscopy. HEADINGS -Intestinal obstruction. Video-assisted surgery.

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“…• Morbid obesity [324], old age, and debilitation are not considered contraindications to laparoscopy (LE 4) [321,325].…”

Section: Ventral Herniasmentioning

confidence: 99%

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

et al. 2012

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Background In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. Methods Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association.

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Laparoscopic management of acute small bowel obstruction

Abstract: Laparoscopy is a useful minimally invasive technique for the management of acute SBO. It is an excellent diagnostic tool and, in most cases, a therapeutic surgical approach in patients with SBO. However, a significant number of patients will require conversion.

Cited by 122 publications

References 15 publications

Laparoscopy for small bowel obstruction: the reason for conversion matters

Laparoscopy for small bowel obstruction: the reason for conversion matters

Analysis of the videolaparoscopy potentiality in the surgical treatment of the bowel obstruction

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