scholarly journals Adhesive Small Bowel Obstruction in the Minimally Invasive Era

2020 ◽  
Author(s):  
Pepijn Krielen ◽  
Martijn W. J. Stommel ◽  
Richard P. G. ten Broek ◽  
Harry van Goor
Keyword(s):  
Minimally Invasive Surgery ◽  
Small Bowel ◽  
Minimally Invasive ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Invasive Surgery ◽  
Adhesion Formation ◽  
Scar Tissue ◽  
Adhesive Small Bowel Obstruction ◽  
Adhesive Band

Roughly 60% of all cases of small bowel obstruction are caused by adhesions. Adhesions are a form of internal scar tissue, which develop in over 45–93% of patients who undergo abdominal surgery. With this relatively high incidence, the population at risk for adhesive small bowel obstruction (ASBO) is enormous. Minimally invasive surgery reduces surgical wound surface and thus holds promise to reduce adhesion formation. The use of minimally invasive techniques results in a 50% reduction of adhesion formation as compared to open surgery. However, since ASBO can be caused by just a single adhesive band, it is uncertain whether a reduction in adhesion formation will also lead to a proportional decrease in the incidence of ASBO. Minimally invasive surgery might also improve operative treatment of ASBO, accelerating gastro-intestinal recovery time and lowering the risk of recurrent ASBO associated with adhesion reformation. We will discuss recent evidence on the impact of minimally invasive surgery on the incidence of ASBO and the role of minimally invasive surgery to resolve ASBO. Finally, we will debate additional measures, such as the use of adhesion barriers, to prevent adhesion formation and adhesion-related morbidity in the minimally invasive era.

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 Minimal invasive surgery for multiple adhesive small bowel obstruction: Results of a comparative multicenter study

2021 ◽  
Vol 89 (6) ◽  
Author(s):  
Daniel Gómez ◽  
Luis F. Cabrera-Vargas ◽  
Mauricio Pedraza ◽  
Andres Mendoza ◽  
Jean A. Pulido-Segura ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Multicenter Study ◽  
Invasive Surgery ◽  
Minimal Invasive Surgery ◽  
Minimal Invasive ◽  
Adhesive Small Bowel Obstruction

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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