World Journal of Emergency Surgery

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.

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...

Surgical Endoscopy and Other Interventional Techniques, 2000

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.

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.

Surgical Laparoscopy, Endoscopy &amp; 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.

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.

Reviews, 1996

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.

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.

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.

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 ...

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.

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.

Cirugía Española (english Edition), 2014

Introduction: Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO). Patients and methods: From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required. Results: The mean age of the 33 patients who underwent surgery was 61.1AE17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83AE44 min and 7.8AE11.2 days, respectively. Operative time (72AE30 vs 123AE63 min.), tolerance to oral intake (1.8AE0.9 vs 5.7AE3.3 days) and length of postoperative stay (4.7AE2.5 vs 19.4AE21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group. Conclusions: In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short stay in hospital and low morbidity); its use would be fully justified in these cases.

Techniques in Coloproctology, 2008

The objective of this review is to present a current opinion on the management of small-bowel obstruction. The topic is limited to small-bowel obstruction secondary to postoperative adhesions. Other causes of smallbowel obstruction are not addressed. We attempt to give readers a concise insight into the evidence available in the English language literature. This paper does not offer a comprehensive review of the topic; rather it highlights some relevant issues and then outlines what role, if any, laparoscopic surgery should play in the management of adhesive small-bowel obstruction.