Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction.

Abstract

Although laparoscopy may be associated with fewer intra-abdominal adhesions and quicker recovery of bowel function, it remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from laparoscopic techniques. The results of patients with acute SBO treated laparoscopically (LAP; n = 52) and conventionally (CONV; n = 52) were compared in a retrospective matched-pair analysis. Conversions were included in the laparoscopic group. Complete laparoscopic treatment was performed in 25 patients (48.1 per cent). Major intraoperative complications occurred in 15 patients in the LAP group and eight in the CONV group (P = 0.156). Intraoperative perforations were more frequent in patients who had undergone more than one previous laparotomy (P = 0.066). Postoperative complications occurred in ten patients (19.2 per cent) in the LAP group and in 21 patients (40.4 per cent) who had conventional surgery (P = 0.032). Bowel movements started 3.5 days after operation in the LAP group and 4.4 days after conventional operation (P = 0.001). The length of hospital stay was 11.3 and 18.1 days respectively (P < 0.001). Laparoscopic treatment of acute SBO was feasible in about half of these patients. Postoperative recovery was improved after laparoscopic procedures but the risk of intraoperative complications increased. A laparoscopic approach seems justified in a subset of patients.