Laparoscopic versus open adhesiolysis for adhesive small bowel obstruction (LASSO): an international, multicentre, randomised, open-label trial

Sallinen, Ville; Saverio, Salomone Di; Haukijärvi, Eija; Juusela, Risto; Wikström, Heidi; Koivukangas, Vesa; Catena, Fausto; Enholm, Berndt; Birindelli, Arianna; Leppäniemi, Ari; Mentula, Panu

doi:10.1016/s2468-1253(19)30016-0

Cited by 90 publications

(68 citation statements)

References 26 publications

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“…Minimally invasive surgery has been associated with less formation of adhesions and recent reviews found a reduction of SBO events and surgery for SBO after laparoscopic colorectal surgery compared with after open surgery [22,23]. The increasing reports of laparoscopic SBO-surgery are promising [24]; however, such surgery seems to be most suitable for adhesive bands. There are several adhesion prevention substances on the market, some of which are in a form of a sheet or film, creating a localised protection area.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms of adhesive small bowel obstruction and outcome of surgery; a population-based study

2020

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Background: This study aims to describe the mechanisms of adhesive small bowel obstruction (SBO) and its morbidity, mortality and recurrence after surgery for SBO in a defined population. Method: Retrospective study of 402 patients (240 women, median age 70 years, range 18-97) who underwent surgery for SBO in the Uppsala and Gävleborg regions in 2007-2012. Patients were followed to last note in medical records or death. Result: The cause of obstruction was a fibrous band in 56% and diffuse adhesions in 44%. Early overall postoperative morbidity was 48 and 10% required a re-operation. Complications, intensive care and early mortality (n = 21, 5.2%) were related to age (p < 0.05) and American Society of Anesthesiologist's class (p < 0.01). At a median follow-up of 66 months (0-122), 72 patients (18%) had been re-admitted because of SBO; 26 of them underwent a re-operation. Previous laparotomies (p = 0.013), diffuse adhesions (p = 0.050), and difficult surgery (bowel injury, operation time and bleeding, p = 0.034-0.003) related to recurrent SBO. The cohort spent 6735 days in hospital due to SBO; 772 of these days were due to recurrent SBO. In all, 61% of the cohort was alive at last follow-up. Late mortality was related to malignancies, cardiovascular disease, and other chronic diseases.Conclusions: About half of patients with SBO are elderly with co-morbidities which predispose to postoperative complications and mortality. Diffuse adhesions, which make surgery difficult, were common and related to future SBO. Overall, nearly one-fifth of patients needed re-admission for recurrent SBO. Continued research for preventing SBO is desirable. Trial registration: The study was registered at ClinicalTrials.gov (NCT03534596, retrospectively registered, 2018-05-24).

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Section: Discussionmentioning

confidence: 99%

Mechanisms of adhesive small bowel obstruction and outcome of surgery; a population-based study

2020

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“…values were used. χ 2 and Kruskal–Wallis tests were used to test for differences between categorical and continuous variables respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Much of the literature addressing the treatment of small bowel obstruction (SBO) focuses on management of the most common cause, adhesions 1‐3 . Emergency treatment of the obstructed abdominal wall hernia contains knowledge gaps that include the optimal surgical approach and type of repair 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Lee¹,

Drake²,

Sayers³

et al. 2020

BJS Open

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Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information

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“…65 With advances in minimal access technology and increasing experience, LAL is recommended. Laparoscopic adhesiolysis reduces the duration of surgery by 50% (P < 0.001), 66,67 postoperative length of stay (by~1.3-2 days), 68 overall complication rate (P = 0.014) with an adjusted OR of 0.37 (P = 0.002), 69 and adhesion reformation. 70 It is also associated with faster GI recovery (e.g., quicker removal of nasogastric tube and passage of flatus).…”

Section: Surgical Managementmentioning

confidence: 99%

“…Risk of open conversion is higher in patients with dense or diffuse adhesions, previous midline laparotomy, iatrogenic injuries, bowel ischemia or perforation, inadequate exposure, need for bowel resection, non-adhesive etiologies of obstruction (e.g., hernia, malignancies), CT scan findings of free abdominal fluid, distended bowel of ≥4 cm, or small bowel feces sign. 69,68 Open conversion does not increase the rate of complications or morbidity. 36,65,69 As thermal injuries could lead to delayed perforation, surgeons must avoid energy-based dissections, and perform sharp scissor dissection with patience.…”

Section: Surgical Managementmentioning

confidence: 99%

Adhesive small bowel obstruction – an update

Tong

Lingam

Shelat

2020

Acute Medicine & Surgery

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Small bowel obstruction (SBO) accounts for 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. Even with the advent of laparoscopic surgery, intra‐abdominal adhesions remain a significant cause of SBO, accounting for 65% of cases. History and physical examination are essential to identify signs of bowel ischemia as this indicates a need for urgent surgical exploration. Another critical aspect of evaluation includes establishing the underlying cause for obstruction and distinguishing between adhesive and non‐adhesive etiologies as adhesive SBO (ASBO) can be managed non‐operatively in 70–90% of patients. A patient with a history of abdominopelvic surgery along with one or more cardinal features of obstruction should be suspected to have ASBO until proven otherwise. Triad of severe pain, pain out of proportion to the clinical findings, and presence of an abdominal scar suggest possible closed‐loop obstruction. Computed tomography has higher sensitivity and specificity compared to plain films and is recommended by the Bologna guidelines. Correcting fluid and electrolyte imbalance is an initial crucial step to mitigate severe hypovolemia. Patients should proceed with surgery if symptoms of bowel compromise are present, or if symptoms do not resolve or have worsened. Surgery is indicated in patients with ischemia, strangulation, perforation, peritonitis, or failure of non‐operative treatment. With advances in minimal access technology and increasing experience, laparoscopic adhesiolysis is recommended. Mechanical adhesion barriers are an effective measure to prevent adhesion formation.

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Laparoscopic versus open adhesiolysis for adhesive small bowel obstruction (LASSO): an international, multicentre, randomised, open-label trial

Abstract: Background

Cited by 90 publications

References 26 publications

Mechanisms of adhesive small bowel obstruction and outcome of surgery; a population-based study

Mechanisms of adhesive small bowel obstruction and outcome of surgery; a population-based study

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Adhesive small bowel obstruction – an update

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