The Incidence and Risk of Early Postoperative Small Bowel Obstruction After Laparoscopic Resection for Colorectal Cancer

Abstract

Early postoperative small bowel obstruction following laparoscopic resection for colorectal cancer occurred in 5.9% of patients. Factors for predicting the development of early postoperative small bowel obstruction in patients with colorectal cancer are variables reflective of a more difficult surgery, rather than pathologic disease severity or anatomical location. In addition, most patients with early postoperative small bowel obstruction improved with conservative treatment, and surgical treatment was rarely needed.

Risk Factors for Early Postoperative Small Bowel Obstruction after Elective Colon Cancer Surgery: An Observational Study of 1,244 Consecutive Patients

“…EPSBO is associated with local inflammatory reactions induced by surgical manipulation. Therefore, although laparoscopic surgery was reported to reduce postoperative inflammatory responses by reducing abdominal wall injury through the delicate handling of the intestines using laparoscopic devices [13], this advantage might be offset by the longer operative time because duration of operation was confirmed as an important independent risk factor for EPSBO both in the present and in previous studies [9].…”

“…In the present study, EPSBO was diagnosed only when a patient had already passed flatus or stool and then ceased to do so. Nakajima et al [8] and Kim et al [9] defined EPSBO as postoperative small bowel obstruction that occurred within 30 days after surgery, without required evidence for the return of small bowel motility before EPSBO; thus, those studies might have overestimated the EPSBO incidence.…”

“…Nakajima et al [8] investigated predisposing factors for EPSBO following colorectal cancer surgery and found that EPSBO was more likely to occur with open colectomy and rectal cancer. In another study of consecutive patients who underwent laparoscopic resection for colorectal cancer, Kim et al [9] identified open conversion, blood transfusion, and an operation time >180 min as independent risk factors for EPSBO in multivariate analysis. Therefore, Kim et al [9] concluded that the factors that predict EPSBO are the variables reflecting a more difficult surgery rather than those indicating pathological disease severity or anatomical location.…”

“…In another study of consecutive patients who underwent laparoscopic resection for colorectal cancer, Kim et al [9] identified open conversion, blood transfusion, and an operation time >180 min as independent risk factors for EPSBO in multivariate analysis. Therefore, Kim et al [9] concluded that the factors that predict EPSBO are the variables reflecting a more difficult surgery rather than those indicating pathological disease severity or anatomical location. Conversely, a regression model created by Shin et al [10] using a similar analysis found poor systemic condition and local remnant tumor as independent risk factors for EPSBO.…”

Complications of laparoscopic rectal cancer surgery

“…Kim et al [45] defined early postoperative small bowel obstruction (SBO), which differs from the POI in that it occurs secondary to early adhesions, lasting less than 7 days and usually resolved conservatively. In a systematic review of postoperative complications after colorectal surgery, early postoperative SBO was the second commonest cause of reoperation, which can be managed with a laparoscopic approach [30] .…”