Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score–Matched Analysis

Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien–Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score–matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score–matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score–matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.

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Laparoscopic Management of Adhesive Small Bowel Obstruction

The American Surgeon ◽

10.1177/000313480707300808 ◽

2007 ◽

Vol 73 (8) ◽

pp. 773-779 ◽

Cited By ~ 11

Author(s):

Marc Zerey ◽

Catherine W. Sechrist ◽

Kent W. Kercher ◽

Ronald F. Sing ◽

Brent D. Matthews ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Laparoscopic Approach ◽

Western World ◽

Adhesive Small Bowel Obstruction ◽

Intraoperative Complication ◽

Working Space ◽

Laparoscopic Adhesiolysis ◽

Procedural Time

Adhesions from prior surgery are the most common cause of small bowel obstruction (SBO) in the Western world. Although laparoscopic adhesiolysis can be performed safely and effectively, the indications and contraindications to the use of laparoscopic techniques in SBO are not clearly defined. The goal of our study was to determine the outcomes of the laparoscopic approach to SBO and discuss patient considerations for its utilization. We retrospectively surveyed all patients undergoing laparoscopic or attempted laparoscopic adhesiolysis performed by the authors between July 1997 and March 2006. Data obtained included patient demographics, clinical and radiologic presentation, and intraoperative and postoperative course. Thirty-three patients underwent laparoscopic adhesiolysis secondary to a SBO. Mean age was 53.6 years (range, 29–84 years) and 64 per cent (21 of 33) were female. Mean body mass index was 30.0 kg/m2 (range, 22.6–46.1 kg/m2). Thirty-one patients (93.9%) had undergone between one and four abdominal surgeries and seven (21.2%) had a previous episode of SBO. There were no patients with peritonitis. Abdominal CT scan was performed preoperatively in 27 patients (81.8%). Laparoscopy diagnosed the site of obstruction in all patients. Twenty-nine patients (88%) were successfully treated laparoscopically. Conversion to laparotomy was required in four cases as a result of dense adhesions and/or a lack of working space. Mean procedural time was 101 minutes (range, 19–198 minutes). There was one intraoperative complication (enterotomy), which was repaired laparoscopically and did not require conversion. Conversion was associated with significantly increased procedural time (129 versus 93 minutes; P = 0.02), but not blood loss or complications. Average times to passage of flatus and first bowel movement were 2.3 days (range, 0.5–5 days) and 3.2 days (range, 1–6 days), respectively. Seven patients (21.2%) had postoperative complications, including wound infection, urinary tract infection, and acute renal insufficiency, all of which occurred in patients completed laparoscopically. One patient had a recurrent SBO 8 months postoperatively managed by repeat laparoscopic lysis of adhesions. Mean postoperative stay was 6 days (range, 1–19 days). There was no hospital mortality. Laparoscopy is safe and feasible in the management of acute SBO in selected patients. It is an excellent diagnostic tool and is therapeutic in most cases.

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The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction

BMC Surgery ◽

10.1186/s12893-019-0504-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 10

Author(s):

Enric Sebastian-Valverde ◽

Ignasi Poves ◽

Estela Membrilla-Fernández ◽

María José Pons-Fragero ◽

Luís Grande

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Surgical Management ◽

Bowel Obstruction ◽

Laparoscopic Approach ◽

Adhesive Small Bowel Obstruction

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Selective Laparoscopic Management of Adhesive Small Bowel Obstruction Using CT Guidance

The American Surgeon ◽

10.1177/000313480907500308 ◽

2009 ◽

Vol 75 (3) ◽

pp. 227-231 ◽

Cited By ~ 3

Author(s):

In Kyu Lee ◽

Do Hyoung Kim ◽

D. Lee Gorden ◽

Yoon Suk Lee ◽

Seung Eun Jung ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Medical Center ◽

Preoperative Imaging ◽

Adhesive Small Bowel Obstruction ◽

Abdominal Ct ◽

Laparoscopic Adhesiolysis ◽

Adhesive Band

Small bowel obstruction after intra-abdominal surgery is a common cause of morbidity necessitating reoperation. The aim of this study was to determine the feasibility of and indications for laparoscopic surgery for acute adhesive small bowel obstruction (AASBO). We conducted a retrospective review of all patients with AASBO who underwent laparoscopic adhesiolysis at a major university medical center. Laparoscopic treatment was performed successfully in 16 patients, and conventional treatment was performed in 13 patients. The rate of conversion from laparoscopic to open was 16.7 per cent. In 15 of 16 total patients who underwent laparoscopic surgery, laparoscopic bandlysis was performed and one patient underwent laparoscopic adhesiolysis. Laparoscopic surgery was performed successfully in nine who had a single adhesive band demonstrated on an abdominal CT, and conventional surgery was performed in all 10 patients without a single adhesive band identified radiographically. Abdominal CT scans facilitate the selection of operative approach for AASBO based on preoperative identification of the obstruction site. Laparoscopic adhesiolysis is a safe and effective treatment modality for patients with AASBO with a single band or single transition zone identified by preoperative imaging.

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Laparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002684 ◽

2020 ◽

Vol 88 (6) ◽

pp. 866-874 ◽

Cited By ~ 1

Author(s):

Pepijn Krielen ◽

Salomone Di Saverio ◽

Richard ten Broek ◽

Claudio Renzi ◽

Mauro Zago ◽

...

Keyword(s):

Systematic Review ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Meta Analysis ◽

Adhesive Small Bowel Obstruction ◽

Open Approach ◽

Short Term

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Effect of the Japanese Herbal Kampo Medicine Dai-Kenchu-To on Postoperative Adhesive Small Bowel Obstruction Requiring Long-Tube Decompression: A Propensity Score Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2011/264289 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Hideo Yasunaga ◽

Hiroaki Miyata ◽

Hiromasa Horiguchi ◽

Kazuaki Kuwabara ◽

Hideki Hashimoto ◽

...

Keyword(s):

Small Bowel ◽

Propensity Score ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Propensity Score Analysis ◽

Kampo Medicine ◽

Hospital Charges ◽

Adhesive Small Bowel Obstruction ◽

Success Rates ◽

Colorectal Cancer Surgery

Adhesive small bowel obstruction (ASBO) is an adverse consequence of abdominal surgery. Although the Kampo medicine Dai-kenchu-to is widely used in Japan for treatment of postoperative ASBO, rigorous clinical studies for its use have not been performed. In the present retrospective observational study using the Japanese diagnosis procedure combination inpatient database, we selected 288 propensity-score-matched patients with early postoperative ASBO following colorectal cancer surgery, who received long-tube decompression (LTD) with or without Dai-kenchu-to administration. The success rates of LTD were not significantly different between Dai-kenchu-to users and nonusers (84.7% versus 78.5%;P=.224), while Dai-kenchu-to users showed a shorter duration of LTD (8 versus 10 days;P=.012), shorter duration between long-tube insertion and discharge (23 versus 25 days;P=.018), and lower hospital charges ($23,086 versus$26,950;P=.018) compared with Dai-kenchu-to nonusers. In conclusion, the present study suggests that Dai-kenchu-to is effective for reducing the duration of LTD and saving costs.

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Should adhesive small bowel obstruction be managed laparoscopically? A National Surgical Quality Improvement Program propensity score analysis

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000156 ◽

2014 ◽

Vol 76 (3) ◽

pp. 696-703 ◽

Cited By ~ 24

Author(s):

Sarah Lombardo ◽

Kerry Baum ◽

Jorge DeAmorim Filho ◽

Ram Nirula

Keyword(s):

Quality Improvement ◽

Small Bowel ◽

Propensity Score ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Propensity Score Analysis ◽

Adhesive Small Bowel Obstruction ◽

Improvement Program ◽

Surgical Quality ◽

Score Analysis

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The Role of Laparoscopy in Small Bowel Obstruction After Previous Laparotomy for Trauma: An Initial Report

The American Surgeon ◽

10.1177/000313481107700218 ◽

2011 ◽

Vol 77 (2) ◽

pp. 184-187

Author(s):

Jon D. Simmons ◽

Emily A. Rogers ◽

John M. Porter ◽

Naveed Ahmed

Keyword(s):

Small Bowel ◽

Ct Scan ◽

Small Bowel Obstruction ◽

Transition Zone ◽

Bowel Obstruction ◽

Laparoscopic Approach ◽

Effective Characteristics ◽

Initial Report ◽

Laparoscopic Adhesiolysis ◽

Previous Laparotomy

Presently, there are no guidelines to help predict which patients are more likely to have successful laparoscopic adhesiolysis. We attempt to define which preoperative characteristics of trauma patients who later develop small bowel obstruction are most amenable to a laparoscopic operation. We did a retrospective review of all patients with small bowel obstruction after previous laparotomy for trauma. For the patients that received an operation to relieve the obstruction, the location of transition zone via CT scan and location of the previous abdominal scar were recorded. A previous upper abdominal surgical incision and a transition zone outside of the pelvis on CT scan were preoperative predictors of a successful laparoscopic adhesiolysis. The laparoscopic group had a shorter length of stay. Laparoscopic surgery as the initial operative approach in the management of SBO after previous laparotomy for trauma is safe and effective. Characteristics that make the laparoscopic approach most favorable are CT transition point above the pelvis and previous midline incision above umbilicus.

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Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2007.01.025 ◽

2007 ◽

Vol 42 (6) ◽

pp. 939-942 ◽

Cited By ~ 63

Author(s):

Kuo Jen Tsao ◽

Shawn D. St Peter ◽

Patricia A. Valusek ◽

Scott J. Keckler ◽

Susan Sharp ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Adhesive Small Bowel Obstruction ◽

Open Approach

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Laparoscopic Adhesiolysis - An Initial Experience of 15 Cases

Journal of Medical Science & Research ◽

10.47648/jmsr.2010.v1502.01 ◽

2010 ◽

Vol 15 (Number 2) ◽

pp. 3-8

Author(s):

B U Khan ◽

A Azim ◽

S Baemon ◽

S I Khan

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Chronic Abdominal Pain ◽

High Rate ◽

Adhesive Small Bowel Obstruction ◽

Surgical Trauma ◽

College Hospital ◽

Laparoscopic Adhesiolysis

Post-operative adhesions frequently occur and can account for various symptoms like chronic abdominal pain and small bowel obstruction. Conventional adhesiolylis by laparotomy results in an unacceptably high rate of recurrence. A minimally invasive procedure (laparoscopic adhesiolysis) might improve she outcome by inflicting less surgical trauma, but well-documented reports focusing on laparoscopic adhesiolysis for chronic abdominal pain and small bowel obstruction is lacking. The aim of this study was to evaluate the efficiency. safety. and outcome of laparoscopic adhesiolysis for recurrent adhesive small-bowel obstruction. Eighty nine patiencs (median age 48 years: range: 25-83 years) operated for small bowel obstruction and chronic abdominal pain in the Depanment of General Surgery, Holy Family Red Crescent Medical College hospital were included for the study. Pre-pensive urgent blood teas and ubdontinal s- ay were done in all patients; 74 patients were treated with traditional laparotomy, while 15 selected patients underwent laparoscopy. For one (6.67%) of the 15 patients treated wits laparoscopy a conversion was necessmy because of the adhesion localization in the posterior abdominal wall, The median stay in hospital was 4.7 days for patients who underwent laparoscopy and 14.3 days for patients treated by traditional laparotonsy. Only one (6.67%) case in laparoscopv group needed to be re-operated, while five (6.76%) cases in laparntonty group needed to be re-operated because of recurrence of obstruction by new adhesions. Overall number of complications contributing to morbidity were significantly lower in those who underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is an effective treatment for small bowel obsommion, morbidity is lower. hospital stay is shorter. and resumption of a novael diet is foster.

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