Laparoscopic management of small bowel obstruction: indications and outcome

León, Enrique Luque-de; Metzger, A.; Tsiotos, Gregory G.; Schlinkert, Richard T.; Sarr, Michael G.

doi:10.1016/s1091-255x(98)80003-6

Cited by 83 publications

(11 citation statements)

References 11 publications

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“…León et al state that a documented history of severe or extensive dense adhesions is a contraindication to laparoscopy [105]. Navez et al [106] found that patients who had only a previous appendectomy were most likely to be successfully managed with laparoscopy.…”

Section: Resultsmentioning

confidence: 99%

“…Other factors such as an elevated white blood cell count or a fever have not been demonstrated to correlate with an increased conversion rate [Suter et al, Navez et al]. One group of patients who are good candidates for laparoscopic adhesiolysis are those with a nonresolving, partial small bowel obstruction or a recurrent, chronic small bowel obstruction demonstrated on contrast study [108,109]. …”

Section: Resultsmentioning

confidence: 99%

“…Leon et al reported a 35% conversion rate in a series of 40 patients and at median follow-up of 12 months, 21 of 26 patients managed laparoscopically or with laparoscopic-assisted procedures remained asymptomatic [135]. …”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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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“…León et al state that a documented history of severe or extensive dense adhesions is a contraindication to laparoscopy [61]. In contrast, Suter et al found no correlation between the number and or type of previous surgeries and the chance of a successful laparoscopic surgery [60].…”

Section: Background Of Wses Guidelinesmentioning

confidence: 99%

“…Other factors such as an elevated white blood cell count or a fever have not been demonstrated to correlate with an increased conversion rate. One group of patients who are good candidates for laparoscopic adhesiolysis are those with a nonresolving, partial small bowel obstruction or a recurrent, chronic small bowel obstruction demonstrated on contrast study [61,62]. …”

Section: Background Of Wses Guidelinesmentioning

confidence: 99%

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Saverio¹,

Catena

Galati³

et al. 2013

World J Emerg Surg

211

136

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BackgroundIn 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.RecommendationsIn absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM 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 decrease recurrence rates or recurrences needing surgery.Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if 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 decrease incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.Adhesions quantification and scoring maybe useful for achieving standardized assessment of adhesions severity and for further research in diagnosis and treatment of ASBO.

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Laparoscopic Contraindications, Complications, and Conversion

Buote¹,

McClaran²

2015

Small Animal Laparoscopy and Thoracoscopy

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Laparoscopic management of small bowel obstruction: indications and outcome

Cited by 83 publications

References 11 publications

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

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

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Laparoscopic Contraindications, Complications, and Conversion

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