Laparoscopic management of mechanical small bowel obstruction
Vincent Bettschart2000, Surgical Endoscopy and Other Interventional Techniques
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Abstract
Background: Laparoscopy is used increasingly for the management of acute abdominal conditions. For many years, previous abdominal surgery and intestinal obstruction have been regarded as contraindications to laparoscopy because there is an increased risk of iatrogenic bowel perforation. The role of laparoscopy in acute small bowel obstruction remains unclear. Methods: Since 1995, data from patients undergoing laparoscopic surgery have been entered prospectively into a database. Patients who underwent surgery before 1995 were added retrospectively to the same database. The charts of all patients treated surgically for mechanical small bowel obstruction were reviewed. Univariate analysis was performed to identify factors associated with success or failure, especially intraoperative complications, conversion, and postoperative morbidity. Stepwise logistic regression was used to assess for independent variables. Results: This study included 83 patients (56 women and 27 men) with a mean age of 56 years (range, 17-91 years). Conversion was necessary in 36 cases (43%). Laparoscopy alone was successful in 47 patients (57%). Intraoperative complications were noted in 16% and postoperative complications in 31% of the patients. Eight reoperations (9%) were necessary. Mortality was 2.4%. Duration of surgery (p < 0.001) and a bowel diameter exceeding 4 cm (p ס 0.02) were predictors of conversion. No risk factor for intraoperative complication was identified. Accidental bowel perforation (p ס 0.008) and the need for conversion (p ס 0.009) were the only independent factors associated with an increased risk of postoperative complications. Conclusions: Laparoscopic management of small bowel obstruction is possible in roughly 60% of the patients selected for this approach. Morbidity is lower, resumption of a normal diet is faster, and hospital stay is shorter than with patients requiring conversion. No clear predictor of success or failure was identified, but intraoperative complications must be avoided. If the surgeon is widely experienced in advanced laparoscopic surgery and there is a liberal conversion policy, laparoscopy is a valuable alternative to conventional surgery in the management of acute small bowel obstruction.
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Laparoscopic treatment of acute small bowel obstruction: A multicentre retrospective study
ANZ Journal of Surgery, 2001
Background : Laparoscopic surgery is thought to promote early recovery and quicker return to bowel function. The objective was to evaluate the rate and predictive factors of success, the causes of failure, the morbidity, and mortality during and after hospitalization, as well as to determine whether laparoscopic treatment of acute small bowel obstruction offers the same benefits as for other laparoscopic procedures. Methods : The records of 308 patients with acute small bowel obstruction treated laparoscopically in 35 centres between 1 October 1988 and 30 September 1996 were retrospectively reviewed. Results : Treatment was implemented completely by laparoscopy ('success' group) in 168 patients (54.6%). Conversion to laparotomy ('failure' group) was required in 140 patients (45.4%; during the same operation in 126 patients and after a median delay of 4 days (range: 1-12 days) in 14 patients). There were significantly more successes in patients with a history of one or two surgical interventions than in those with more than two (56% vs 37%; P < 0.05). There were significantly more successes in patients who had undergone appendectomy only (67/94; 71%) than in patients who (i) had no antecedent surgery (52%; P < 0.05), or (ii) underwent other surgery (33%; P < 0.001). The rate of success was significantly higher ( P < 0.001) in patients operated on early (< 24 h) and in patients with bands (54%), than in those with adhesions (31%) or with other causes of obstruction (15%). The median duration of postoperative ileus was significantly shorter in the 'success' group than in the 'failure' group (2 days vs 4 days; P < 0.001). The median duration of postoperative hospital stay was shorter in the 'success' group than in the 'failure' group (4 days vs 10 days; P < 0.001). Fewer immediate wound complications were sustained in the 'success' group than in the 'failure' group (1.2% vs 10.7%; P < 0.001). The total number of immediate or delayed complications and particularly the number of recurrent obstructions after hospitalization as well as the number of deaths did not differ significantly between the two groups. Conclusions : Successful laparoscopic treatment of small bowel obstruction can be expected in patients who are seen early, and who have had one or two previous interventions (particularly appendectomy, especially if bands are found).
Predictors of Failure of the Laparoscopic Approach for the Management of Small Bowel Obstruction
The American Surgeon, 2010
Small bowel obstruction (SBO) is a common cause of hospital admission. Our objective is to determine variables that correlate with failure of the laparoscopic approach for SBO. Twenty-three consecutive patients underwent diagnostic laparoscopy with curative intent for treatment of SBO by a single surgeon over a 3-year period. The laparoscopic approach was successful in 18 patients (78%); there were five (22%) conversions to laparotomy. The causes of obstruction included adhesive band in 16 patients; and small bowel lymphoma, metastatic esophageal cancer, small bowel gangrene, Meckel diverticulum, gallstones ileus, and incarcerated incisional hernia in two. Using the Fisher two-sided test, no significant predictor for conversion was identified using gender, American Society of Anesthesiologists class, previous bowel obstruction, history of adhesiolysis, abdominal distention, pelvic surgeries, chemotherapy, radiation, malignancy, chronic obstructive pulmonary disease, asthma, coronary...
Laparoscopic management as the initial treatment of acute small bowel obstruction
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
We prospectively evaluated our experience with laparoscopic management of acute small bowel obstruction (SBO). The study group included all patients requiring surgical intervention based on complete mechanical SBO by clinical assessment or who had failed conservative management. Patients with malignant causes were excluded. Experienced laparoscopic surgeons performed all operations. Between January 1998 to January 2003, 61 patients required operative intervention for acute SBO. Causes included adhesions, internal hernia, incarcerated incisional hernia, and inflammatory bowel disease. Laparoscopic techniques (LAP) alone were successfully used to complete 41 cases (67%). Twenty patients (33%) were converted (CONV) to either mini-laparotomy [7 patients (35%)] or standard midline laparotomy [13 patients (65%)]. A single band was identified in 25 patients (41%). Complications occurred in both groups. We believe all patients requiring surgery in the setting of acute small bowel obstructio...
Feasibility of laparoscopy for small bowel obstruction
World Journal of Emergency Surgery, 2009
Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. Results The feasibility of diagnostic laparoscopy is high (60–100%), while that of therapeutic laparoscopy is low (40–88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. Conclusion Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.
Laparoscopic management of small bowel obstruction: indications and outcome
Journal of Gastrointestinal Surgery, 1998
The use of laparoscopy in the treatment of acute small bowel obstruction (SBO) faces inherent obstacles, including dilated loops of bowel, a limited working space, and postoperative adhesions. The objective of this study was to outline the efficacy of laparoscopic management of SBO in children. Methods: With Institutional Review Board (IRB) approval, children who presented with a diagnosis of SBO and underwent management via a laparoscopic approach at our institution from January 2001 to December 2008 were retrospectively reviewed. Medical records were reviewed for age, weight, etiology of obstruction, radiographic findings, need for conversion, number of operations, length of stay, and postoperative complications. Statistical analyses of data comparison between those patients who were managed utilizing a laparoscopic approach and those in whom the laparoscopic approach was converted to a laparotomy were performed using a Chi-squared or a two-tailed Student's t-test with significance reported for P < 0.05. Results: Thirty-four patients underwent laparoscopic management of SBO. Mean age was 8.1 AE 5.9 years with a mean weight of 32.8 AE 24.6 kg. Sixty-seven percent were male. A preoperative computed tomography scan was obtained in 21 patients (62%). Eleven cases (32%) required conversion to laparotomy. The most common reason for conversion to the open approach was poor working space (45.4%) followed by intestinal volvulus (27.2%), inability to identify source of obstruction (18.2%), and enterotomy (9%). The most common cause of SBO was postoperative adhesions (73.5%), followed by Meckel's diverticulum (8.8%), volvulus (8.8%), and other (8.8%). Postoperative complications occurred in 5 patients (14.7%). One patient died within 30 days of exploration due to intestinal ischemia secondary to midgut volvulus and subsequent septic shock. Five patients (14.7%) had a recurrent SBO with a mean time to recurrence of 2.6 AE 2.1 months. There were no significant differences in demographic or preoperative variables between patients who were successfully managed with laparoscopy alone versus those patients in whom conversion to laparotomy was necessary. In patients who required conversion, the laparoscopic evaluation did aid in identifying the etiology and allowed for a directed surgical approach when appropriate. Conclusions: Laparoscopy for the management of SBO in children is safe and can be therapeutic in the majority of patients. We recommend that consideration for initial exploration in children with SBO be carried out via the laparoscopic approach, with an understanding that conversion to an open approach may be necessary to complete the operation.
Laparoscopic versus open adhesiolysis for small bowel obstruction - a multicenter, prospective, randomized, controlled trial
BMC Surgery, 2014
Background: Laparoscopic adhesiolysis is emerging as an alternative for open surgery in adhesive small bowel obstruction. Retrospective studies suggest that laparoscopic approach shortens hospital stay and reduces complications in these patients. However, no prospective, randomized, controlled trials comparing laparoscopy to open surgery have been published.
Is laparoscopy feasible and effective for acute postoperative small bowel obstruction in Africa ? A case report in Yaoundé, Cameroon
Pan African Medical Journal, 2016
Laparoscopic management of acute adhesive small bowel obstruction has been shown to be feasible and advantageous. However, widespread acceptance and application is still not observed. We describe the case report of a 58-year-old male who presented with signs and symptoms of small bowel obstruction status twenty years after two consecutive open surgeries for complicated acute appendicitis. The patient underwent successfully a laparoscopic band lysis after failure of conservative management. This is the first report of laparoscopic management of adhesive small bowel obstruction in Cameroon. Laparoscopic adhesiolysis of acute adhesive small bowel obstruction is feasible and safe by skilled surgeons in selected patients even in developing countries.
Laparoscopic diagnosis and treatment of intestinal obstruction
Surgical Endoscopy, 2004
Background: Intestinal obstruction is a common reason for general surgical referral. The traditional approach has been conservative management, followed by laparotomy if conservative measures are unsuccessful. However, with the advent of minimally invasive surgery, the need for laparotomy for this common problem is being challenged. Methods: From May 1991 to April 2001, 167 patients underwent laparoscopy for diagnosis and/or treatment of intestinal obstruction. Average patient age was 62 years (range, 21-98). The site of obstruction was the stomach in seven patients, small bowel in 116 patients, and colon in 44 patients. Results: Laparoscopy successfully diagnosed the site of obstruction in all patients. In addition, 154 patients (92.2%) were successfully treated laparoscopically without conversion to laparotomy. Both intraoperative and postoperative complication rates were low (3.5 and 18.6%, respectively) and compared favorably with those of published reports. Conclusions: Intestinal obstruction can be approached safely and effectively by laparoscopy with the intent not only to correctly diagnose the patient but also to render treatment.
Laparoscopically assisted bowel surgery
Surgical Endoscopy, 1995
In order to help determine the risks and benefits, we retrospectively analyzed the results of our first 114 laparoscopically assisted bowel procedures. Procedures performed consisted of partial colectomy (85), total or subtotal abdominal colectomy (8), total proctocolectomy with J-pouch ileal reservoir (I 1), and diverting procedures (10). Forty-nine procedures were for malignancy. The rate of conversion to laparotomy was 13.2%. Oral feedings were resumed in 2.4 days (range 1-5), and bowel function returned in 3.8 days (range 2-8). The average length of stay was 4.2 days for partial colectomy and 6 days for total, subtotal, and proctocolectomy. The mean return to normal activity for all groups was 16.7 days (10.8 days for partial colectomy). There were no deaths. Major morbidity (6%) consisted of abscess (3), anastomotic leak (2), and hemorrhage (1). Mean operative costs analyzed for the initial 37 patients were higher for laparoscopic colectomies when compared to traditional colectomies; however, the mean total hospital costs were less for the laparoscopic procedures. These data suggest that the laparoscopic approach to colorectal resection is an acceptable alternative to laparotomy for a variety of disease processes, allowing patients an early return to normal activity.
Early outcomes of surgery for small bowel obstruction: analysis of risk factors
Langenbeck's Archives of Surgery, 2007
Objectives The study aimed to review the etiologies of patients who underwent surgery for small bowel obstruction (SBO) and to evaluate the risk factors affecting the early postoperative outcomes. Materials and methods A case series of 430 patients (252 men) with a mean age of 64.5 years, who underwent 437 operations for SBO, were retrospectively reviewed. Results Peritoneal adhesions and hernia were the most common causes of SBO, contributing 42.3 and 26.8% of all cases, respectively. Strangulation occurred in 27.7% and caused nonviable bowel in 13.0% of obstructing episodes. Old age (age≥70 years), female patient, nonadhesive obstruction, and hernia were the independent significant factors associated with bowel strangulation. The 30-day mortality was 6.5%, and the median postoperative hospital stay was 8 days. Old age, the presence of premorbid pulmonary disease, and malignant obstruction were the independent factors associated with operative mortality. The overall complication rate was 35.5%, and old age was the only significant factor associated with postoperative complications. Conclusions Surgery for SBO is still associated with significant mortality and morbidity. As old age is significantly associated with an increased incidence of strangulation, operative mortality, and complications, this group of patients should be managed with extra cautions to avoid unfavorable outcome of surgery.
Related papers
Contribution of laparoscopy in small bowel obstruction: Report on two rare causes of small bowel obstruction
Apollo Medicine, 2017
Introduction: Bowel obstruction occurs when the normal flow of intraluminal content is interrupted. The most common cause of small bowel obstruction is adhesion but other rare causes of intestinal obstruction have also been reported as fecolith, foreign body or bezoar, GIST, and abdominal cocoon. Laparoscopy as diagnostic as well as therapeutic tool in small bowel obstruction seems to be useful. Methods: We described two rare causes of intestinal obstruction. The aim of the present article is to stress the role of laparoscopy associated with computed tomography (CT) in diagnostic confirmation of causes of intestinal obstruction as well as reasons for conversion. We also reviewed the relevant published literature. Result: CASE 1: A 63-year-old female presented with history of recurrent episodes of pain in left side of abdomen for 1 year. Contrast Enhanced Computed Tomography (CECT) showed rounded radiopaque foreign body in distal jejunum. Laparoscopic adhesiolysis and reduction of hernial content were done. Laparoscopic surgery converted to open for removal of foreign body and hernioplasty. CASE 2 64 year elderly male presented with history of intermittent episodes of colicky pain in periumbilical region for 1 month. CECT abdomen showed abdominal cocoon. Pneumoperitoneum access was not succeeded, thus exploratory laparotomy and adhesiolysis was done. Conclusion: In small bowel obstruction, diagnostic laparoscopy has to be done for confirmation of diagnosis and if possible to release the cause of obstruction, but conversion to open by giving either small incision or exploratory laparotomy should be the choice to completely remove the cause for the further prevention of recurrence and complications.
Elective Laparoscopy in Diagnosis and Treatment of Recurrent Small Bowel Obstruction
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2006
Background: To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. Methods: Retrospective analysis of 253 patients who underwent therapeutic laparoscopy for recurrent small bowel obstruction from June 1996 to May 2005 was carried out. Patients with acute small bowel obstruction, bowel obstruction due to tumor, and obstructed inguinal hernias were excluded from analysis. Results: Laparoscopy diagnosed cause of obstruction in all except 3 (1.18%) patients. The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%). One hundred sixty nine patients were managed totally laparoscopically with adhesiolysis. Therapeutic bowel intervention other than adhesiolysis was required in 84 patients, of which 33 procedures were performed totally laparoscopically and remaining 51 procedures were completed with laparoscopically guided target incision. Five patients required conversion to open celiotomy. Iatrogenic enterotomies occurred in 3 patients and small bowel perforation during manipulation occurred in 1 patient. Postoperative procedure-related complications were seen in 44 patients. There was one mortality due to postoperative arrhythmia and cardiac failure. Conclusions: Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases.
LAPAROSCOPIC MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION
ANZ Journal of Surgery, 1993
Acute small bowel obstruction is commonly due to band adhesions. In the past it has had an overall mortality rate of up to 11% for elderly patients. In this paper we report three cases of small bowel obstruction, treated by laparoscopic division of the causative bands. All patients recovered rapidly and were discharged within 5 days of surgery.
Etiology and Management of Small Bowel Obstruction with Special Reference to Role of Laparoscopy—A Single Centre Experience
Surgical Science, 2019
Background: Small bowel obstruction (SBO) is the commonly diagnosed disease in the emergency department. The diagnosis and management of small bowel obstruction varies among institutions. The role of laparoscopy in the management of small bowel obstruction is debatable. Aim: To study the profile, clinical features and management options of patients of small bowel obstruction with special emphasis on role of laparoscopy. Material and Methods: 51 consecutive patients with documented small bowel obstruction admitted in our department were studied from June 2016 to December 2018. All the patients above 12 years of age with small bowel obstruction were included. The diagnosis of small bowel obstruction (SBO) was made in these cases by detailed history, clinical examination and investigations. All these patients were received and adequately resuscitated. Non-operative (conservative) treatment was confirmed to those who met the standard parameters for such treatment and early surgical treatment was carried out whenever indicated. The operative procedure done was laparoscopy or open depending on the clinical features and condition of patient. Results: In our study, 51 patients mean age was 44.7 years with 27 Males and 24 females. 28 (54.9%) patients of our study presented with continuous abdominal pain followed by colicky pain in 23 (45.1%) patients. 34 (66.7%) patients on admission gave history of effortless vomiting. Distension of abdomen was present in 30 (58.8%) patients and constipation was present in 40 (78.4%) of our studied patients. On CT scan interloop fluid was present in 23 (45.1%) patients while transition point was present in 31 (60.8%) patients. Adhesion obstruction was found to be most common cause of obstruction 27 (52.9%) patients, followed by malignancy in 8 (15.7). 25 (49.0%) patients were managed conservatively and 26 (51%) were operated. 11 (21.6%
Laparoscopy is a safe option in selected small bowel obstructions: A case report
Case report international, 2018
traditionally, exploratory laparotomy has been the mainstay of treatment for patients requiring surgery in the emergency setting; however with increased benefits of laparoscopic approach, surgeons are more tempted to use laparoscopy in the emergency setting also. A 51-year-old man presented to the emergency department with acute abdominal pain secondary to small bowel obstruction by a foreign body. the patient underwent a laparoscopic operation and removal of foreign body by a small enterotomy without any complications and made a good recovery. this case and review of literature demonstrates that laparoscopic approach is a feasible option for treatment and diagnosis of selected small bowel obstructions.
Laparoscopic surgery for intestinal obstruction
Surgical endoscopy, 1995
The indications for laparoscopic surgery have steadily diversified over the last several years. At the present time, the level of comfort with laparoscopic procedures has allowed surgeons to perform procedures which several years ago never would have been attempted. One of the indications for surgery which has only recently been appreciated is bowel obstruction. Specifically, in the last several years a number of authors have described successful application of the laparoscope to treat patients with either acute or chronic bowel obstruction. This article reviews the indications and contraindications for the procedure as well as recommended preoperative evaluation and suggested surgical technique. Furthermore, the early results in these few series is discussed.
Single-port laparoscopic treatment of small bowel obstruction
American journal of surgery, 2014
The aim of this study was to report our initial experience with single-port laparoscopic surgery (SPLS) for small bowel obstruction (SBO). Between October 2009 and April 2013, 36 patients underwent SPLS for SBO. SPLS was performed transumbilically. Patient demographics and operative and postoperative outcomes were analyzed. SPLS for SBO was successful in 35 patients. In 1 patient, a conversion to laparotomy was required. The median incision length, operative time, and postoperative length of stay were 2.3 cm (range, 1.5 to 5.0 cm), 115 min (range, 30 to 250 min), and 8 days (range, 3 to 26 days), respectively. The median time to resume oral intake was 3 days (range, 1 to 16 days). The intra- and postoperative complication rates were 6% and 11%, respectively. SPLS was a safe and feasible therapeutic approach for SBO and may also be an excellent diagnostic tool when performed by an experienced SPLS surgeon in selected patients.
Laparoscopic Small Bowel Surgery
Laparoscopic surgery has revolutionized the field of gastrointestinal surgery, offering numerous advantages in terms of reduced postoperative pain, shorter hospital stays, and faster recovery. Small bowel surgery, in particular, has benefited from the minimally invasive approach. This abstract provides a concise overview of the key aspects of laparoscopic small bowel surgery, including patient selection, surgical techniques, outcomes, and recent advancements. Patient selection plays a pivotal role in the success of laparoscopic small bowel surgery. The appropriate candidate selection criteria, such as bowel disease type, location, and patient's overall health, are discussed. Surgical techniques employed in laparoscopic small bowel surgery, including port placement, trocar insertion, and bowel mobilization, are outlined to provide a comprehensive understanding of the procedure. The abstract also highlights the clinical outcomes associated with laparoscopic small bowel surgery, emphasizing reduced postoperative pain, shorter hospital stays, and quicker return to normal activities. Complications and their management are briefly addressed, underscoring the importance of surgical expertise in achieving optimal results. Furthermore, this abstract sheds light on recent advancements in laparoscopic small bowel surgery, including the use of robotic-assisted techniques, enhanced imaging modalities, and innovative instrumentation. These developments have further improved surgical precision and patient outcomes. In conclusion, laparoscopic small bowel surgery has emerged as a highly effective and minimally invasive approach to treat various small bowel pathologies. This abstract provides a comprehensive overview of the key aspects and recent advancements in this field, emphasizing the potential benefits it offers to both patients and surgeons.
The Role of Laparoscopy in Small Bowel Obstruction After Previous Laparotomy for Trauma: An Initial Report
The American Surgeon, 2011
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 ...
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