Skip to main content
SpringerLink
Log in

Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Adhesional small bowel obstruction (SBO) occurs in 14–17 % of patients within 2 years of open colorectal or general surgery. The aim of this pooled analysis is to compare the safety and efficacy of laparoscopic versus open treatment of SBO.

Methods

An electronic search of Embase, Medline, Web of Science, and Cochrane databases was performed. Weighted mean differences (WMDs) were calculated for the effect size of laparoscopic surgery on continuous variables, and pooled odds ratios (PORs) were calculated for discrete variables.

Results

There were eleven non-randomized comparative studies included this review. Laparoscopic surgery was associated with a significant reduction in mortality (POR = 0.31; 95 % CI 0.16–0.61; P = 0.0008), overall morbidity (POR = 0.34; 95 % CI 0.27–0.78; P < 0.0001), pneumonia (POR = 0.31; 95 % CI 0.20–0.49; P < 0.0001), wound infection (POR = 0.29; 95 % CI 0.12–0.70; P = 0.005), and length of hospital stay (WMD = −7.11; 95 % CI −8.47 to −5.75; P < 0.0001). The rates of bowel injury and reoperation were not significantly different between the two groups. Operative time was significantly longer in the laparoscopic group (WMD = 72.31; 95 % CI 60.96–83.67; P < 0.0001).

Conclusion

Laparoscopic surgery for treatment of adhesional SBO improves clinical outcomes and can be performed safely in selected cases with similar rates of bowel injury and reoperation to open surgery. Large scale randomized controlled trials are needed to validate the findings of this pooled analysis of non-randomized data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Beck DE, Opelka FG, Bailey HR, Rauh SM, Pashos CL (1999) Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery. Dis Colon Rectum 42(2):241–248

    Article  CAS  PubMed  Google Scholar 

  2. Barkan H, Webster S, Ozeran S (1995) Factors predicting the recurrence of adhesive small-bowel obstruction. Am J Surg 170(4):361–365

    Article  CAS  PubMed  Google Scholar 

  3. Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1(4):259–262

    Article  CAS  PubMed  Google Scholar 

  4. Mancini GJ, Petroski GF, Lin W-C, Sporn E, Miedema BW, Thaler K (2008) Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg 207(4):520–526

    Article  PubMed  Google Scholar 

  5. Gutt CN, Oniu T, Schemmer P, Mehrabi A, Büchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18(6):898–906

    Article  CAS  PubMed  Google Scholar 

  6. Van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218

    Article  PubMed  Google Scholar 

  7. Bartels SAL, Vlug MS, Hollmann MW, Dijkgraaf MGW, Ubbink DT, Cense HA et al (2014) Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101(9):1153–1159

    Article  CAS  PubMed  Google Scholar 

  8. Reshef A, Hull TL, Kiran RP (2013) Risk of adhesive obstruction after colorectal surgery: the benefits of the minimally invasive approach may extend well beyond the perioperative period. Surg Endosc 27(5):1717–1720

    Article  CAS  PubMed  Google Scholar 

  9. Burns EM, Currie A, Bottle A, Aylin P, Darzi A, Faiz O (2013) Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery. Br J Surg 100(1):152–159

    Article  CAS  PubMed  Google Scholar 

  10. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  11. Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  12. Chopra R, McVay C, Phillips E, Khalili TM (2003) Laparoscopic lysis of adhesions. Am Surg 69(11):966–968

    PubMed  Google Scholar 

  13. Davies SW, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T et al (2014) A comparative analysis between laparoscopic and open adhesiolysis at a tertiary care center. Am Surg 80(3):261–269

    PubMed  Google Scholar 

  14. Grafen FC, Neuhaus V, Schöb O, Turina M (2010) Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 395(1):57–63

    Article  PubMed  Google Scholar 

  15. Johnson KN, Chapital AB, Harold KL, Merritt MV, Johnson DJ (2012) Laparoscopic management of acute small bowel obstruction: evaluating the need for resection. J Trauma Acute Care Surg 72(1):25–30

    PubMed  Google Scholar 

  16. Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG et al (2007) Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc 21(5):742–746

    Article  CAS  PubMed  Google Scholar 

  17. Lombardo S, Baum K, Filho JD, Nirula R (2014) Should adhesive small bowel obstruction be managed laparoscopically? A National Surgical Quality Improvement Program propensity score analysis. J Trauma Acute Care Surg 76(3):696–703

    Article  PubMed  Google Scholar 

  18. Mathieu X, Thill V, Simoens C, Smets D, Ngongang C, Debergh N et al (2008) Laparoscopic management of acute small bowel obstruction: a retrospective study on 156 patients. Hepatogastroenterology 55(82–83):522–526

    CAS  PubMed  Google Scholar 

  19. Okamoto H, Wakana H, Kawashima K, Fukasawa T, Fujii H (2012) Clinical outcomes of laparoscopic adhesiolysis for mechanical small bowel obstruction. Asian J Endosc Surg 5(2):53–58

    Article  CAS  PubMed  Google Scholar 

  20. Simmons JD, Rogers EA, Porter JM, Ahmed N (2011) The role of laparoscopy in small bowel obstruction after previous laparotomy for trauma: an initial report. Am Surg 77(2):185–187

    PubMed  Google Scholar 

  21. Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90(9):1147–1151

    Article  CAS  PubMed  Google Scholar 

  22. Schwenk W, Böhm B, Witt C, Junghans T, Gründel K, Müller JM (1999) Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 134(1):6–12

    Article  CAS  PubMed  Google Scholar 

  23. Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ et al (2012) Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 204(6):952–957

    Article  PubMed  Google Scholar 

  24. Levard H, Boudet M-J, Msika S, Molkhou J-M, Hay J-M, Laborde Y et al (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71(11):641–646

    Article  CAS  PubMed  Google Scholar 

  25. Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V (2000) Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Surg Endosc 14(5):478–483

    Article  CAS  PubMed  Google Scholar 

  26. Dindo D, Schafer M, Muller MK, Clavien P-A, Hahnloser D (2010) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24:792–797

    Article  CAS  PubMed  Google Scholar 

  27. Uranues S, Salehi B, Bergamaschi R (2008) Adverse events, quality of life, and recurrence rates after laparoscopic adhesiolysis and recurrent incisional hernia mesh repair in patients with previous failed repairs. J Am Coll Surg 207(5):663–669

    Article  PubMed  Google Scholar 

Download references

Disclosures

Mr Tom Wiggins, Mr Sheraz R. Markar, and Mr Adrian Harris have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, London, UK

    Tom Wiggins & Sheraz R. Markar

  2. Department of Laparoscopic and Upper Gastro-Intestinal Surgery, Hinchingbrooke Healthcare NHS Trust, Huntingdon, UK

    Adrian Harris

Authors
  1. Tom Wiggins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheraz R. Markar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adrian Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrian Harris.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wiggins, T., Markar, S.R. & Harris, A. Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis. Surg Endosc 29, 3432–3442 (2015). https://doi.org/10.1007/s00464-015-4114-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4114-0

Keywords

Search

Navigation