Laparoscopic Management of Intestinal Obstruction

Abstract

Laparoscopic adhesiolysis is a valuable tool for the surgeon performing complex minimally invasive procedures. It can be used for the management of intestinal obstruction and chronic abdominal pain syndromes. It is also an essential skill when performing laparoscopic surgery on patients who had prior abdominal operations. The use of laparoscopy for patients with an intestinal obstruction was once considered an absolute contraindication. With the advancement in optics and increasing experience, more and more surgeons are turning to laparoscopy as a useful diagnostic and therapeutic tool in more complex situations.

A preliminary experience in the laparoscopic approach to bowel obstruction

“…In this sense, we believe that a CAT scan prior to surgery is extremely useful in deciding upon both the indication for surgery and the approach. 3,4 On the other hand, according to the bibliography reviewed and our own experience, the anesthetics used in relation to the patient's status, the suspicion of obstruction due to peritoneal carcinomatosis, intestinal distension greater than 4 cm in imaging studies, and the suspicion of dense adhesions, can all be considered relative contraindications. 3,5,14 Likewise, the use of the laparoscopic approach in patients suspected of presenting with ischemia or peritonitis is controversial and regarded by certain groups as relatively contraindicated.…”

“…As we stated before, dissection must be performed with care, avoiding traction on the intestinal segments and taking great precautions when using electrocoagulation. 4 By following these principles, the complication rate can be lowered. Likewise, another recommended surgical maneuver is pneumoperitoneum creation through an open technique to avoid intestinal injury due to patient adhesion syndrome.…”

“…If that is not possible through laparoscopy, then the conversion to laparotomy is obligatory. 4,5,8,10 Basically, the role of the laparoscopic approach in this field is to prevent future adhesions that would cause bowel obstruction recurrence, with the consequent socioeconomic costs this implies. To the best of our knowledge, no report in relation to this aspect has been carried out for Spain, but in the United States such a cost is an estimated 1.3 billion dollars per year.…”

“…To the best of our knowledge, no report in relation to this aspect has been carried out for Spain, but in the United States such a cost is an estimated 1.3 billion dollars per year. 4 The higher perioperative costs of laparoscopy could be compensated for by such annual expense.…”

Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia

“…The role of laparoscopy in patients with intestinal obstruction is being increasingly recognised. [10] The intervention is preferably undertaken when the acute episode has resolved and the abdominal distention settled down. However, in experienced hands, there is a definite role for diagnostic laparoscopy in selected patients during acute small bowel obstruction, provided that certain tenets are adhered to.…”