scholarly journals Laparoscopic Adhesiolysis - An Initial Experience of 15 Cases

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.

Selective Laparoscopic Management of Adhesive Small Bowel Obstruction Using CT Guidance

2009 ◽  
Vol 75 (3) ◽  
pp. 227-231 ◽  
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.

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

2016 ◽  
Vol 106 (1) ◽  
pp. 28-33 ◽  
Author(s):  
T. Hackenberg ◽  
P. Mentula ◽  
A. Leppäniemi ◽  
V. Sallinen
Keyword(s):  
Small Bowel ◽  
Propensity Score ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Open Surgery ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Adhesive Small Bowel Obstruction ◽  
Open Approach ◽  
Laparoscopic Adhesiolysis

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.

scholarly journals Double balloon enteroscopy: Bangladesh experience

2014 ◽  
Vol 39 (3) ◽  
pp. 116-119 ◽  
Author(s):  
NC Nath ◽  
SC Dhar ◽  
AFMH Uddin ◽  
BC Shil ◽  
RK Banik ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Chronic Diarrhea ◽  
Chronic Abdominal Pain ◽  
Gi Bleeding ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Double Balloon

Double balloon enteroscopy (DBE) is a newly developed endoscopic modality for diagnosis and treatment of small bowel disorders. The aim of this study was to evaluate the diagnostic and therapeutic impact of DBE in patient with suspected small bowel disease. This was a prospective study. Sixty one double balloon enteroscopy procedures (30 antegrade 31 retrograde) were done in thirty six patients(20M/16F, mean age 40±12.5 range 16-65 years ) at gastroenterology department, Sir Salimullah Medical College, Dhaka between October 2011 and September 2012. Indications for DBE included chronic abdominal pain 14(38.9%), obscure GI bleeding 11(30.56%), Small bowel obstruction 05(13.89%), and chronic diarrhea 06(16.67%). The morphologic findings were ulcerations 13(36.11%), growth 03(8.33%), vascular ectasia 03(8.33%) and polyp 01(2.78%). Therapeutic interventions were performed in one patient only. No serious complications were observed. Diagnostic yields in case of chronic abdominal pain, chronic diarrhea, obscure GI bleeding and small bowel obstruction were 50%, 66%, 63% and 40% respectively. The findings were adenocarcinoma 04(11%), lymphoma 03(8.4%), tuberculosis 03(8.4%), non specific findings 05(13.9%), IPSID 01(2.8%), crohn’s disease 01(2.8%), vascular ectasia 03(8.33%) and normal 16(44.44%). DBE is well tolerated, feasible and useful technique for the diagnosis as well as treatment of small intestinal disorders. DOI: http://dx.doi.org/10.3329/bmrcb.v39i3.20311 Bangladesh Med Res Counc Bull 2013; 39: 116-119

scholarly journals Efficacy and timing of gastrografin administration after ileus tube insertion in patients with adhesive small bowel obstruction

2020 ◽  
Author(s):  
Yu Tamura ◽  
Mitsuru Esaki ◽  
Ryoji Ichijima ◽  
Sho Suzuki ◽  
Maho Iwamoto ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
High Rate ◽  
Adhesive Small Bowel Obstruction ◽  
Background Characteristics ◽  
Total Period ◽  
Therapeutic Outcomes

Abstract Background: Gastrointestinal decompression through ileus tube is useful for the treatment of adhesive small bowel obstruction (ASBO). Gastrografin administration through the ileus tube is performed if decompression therapy fails to relieve obstruction. However, the efficacy and appropriate timing of gastrografin administration are unclear. This study aimed to evaluate the efficacy of gastrografin administration within 48 h after admission. Methods: This retrospective study used the data of patients with ASBO admitted to our hospital between January 2014 and August 2018 and included those who underwent ileus tube intubation but did not achieve obstruction relief for over 24 h after admission. The patients were classified into the following two groups: those treated with gastrografin administration within 48 h after admission (EGA group) and those treated without gastrografin administration within 48 h after admission (non-EGA [NEGA] group). Propensity-score matching was performed to compensate for confounding differences between the groups. The short-term outcomes including the rate of successful conservative management without surgery, the period until the first stool, the period of ileus tube intubation, the total period of hospital admission, and adverse events due to gastrografin administration were evaluated and compared between the two groups. Results: This study included 152 patients: 67 in the EGA group and 85 in the NEGA group. Fifty-five pairs were matched with similar background characteristics. After matching, the rates of successful conservative management were 89.1% (49/55) and 94.5% (52/55) in the matched EGA and NEGA groups, respectively (P=0.49). Although the median insertion days of ileus tube in the NEGA group were significantly lesser than those in the EGA group (7 [5–9] vs. 5 [4.5–7], P=0.017), other therapeutic outcomes did not differ significantly. In the NEGA group, 5.5% (3/55) achieved obstruction relief without gastrografin administration. Aspiration pneumonia occurred in one patients of EGA group. Conclusions: Gastrografin administration with ileus tube achieved a high rate of successful conservative management. Follow-up by decompression with ileus tube for at least 48 h after admission is required in patients with ASBO, which may avoid unnecessary gastrografin administration and consequently reduce the total cost of treatment.

Laparoscopic Management of Adhesive Small Bowel Obstruction

2007 ◽  
Vol 73 (8) ◽  
pp. 773-779 ◽  
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.

scholarly journals Acute adhesive small-bowel obstruction: laparotomy or laparoscopy

2018 ◽  
Vol 99 (3) ◽  
pp. 508-514
Author(s):  
I S Malkov ◽  
E B Bagautdinov ◽  
I F Sharafislamov ◽  
S R Zogot ◽  
Dz Kh Misiev
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Methods ◽  
Abdominal Pressure ◽  
Adhesive Small Bowel Obstruction ◽  
Diffuse Peritonitis ◽  
Laparoscopic Adhesiolysis ◽  
Radiological Methods

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment. Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders. Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy). Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

Adhesive Small Bowel Obstruction Protocol in Geriatric Patients

2019 ◽  
Vol 229 (4) ◽  
pp. S87
Author(s):  
Jose A. Aldana ◽  
Javier E. Rincon ◽  
Ricardo A. Fonseca ◽  
Rohit K. Rasane ◽  
Christina X. Zhang ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Geriatric Patients ◽  
Adhesive Small Bowel Obstruction

scholarly journals Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021 ◽  
pp. 145749692098276
Author(s):  
M. Podda ◽  
M. Khan ◽  
S. Di Saverio
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Bowel Ischemia ◽  
Current Evidence ◽  
First Episode ◽  
Adhesive Small Bowel Obstruction ◽  
Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

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