Advertisement

International Journal of Colorectal Disease

, Volume 31, Issue 5, pp 1011–1019 | Cite as

Laparoscopy for bowel obstruction—a contradiction? Results of a multi-institutional survey in Germany

  • M. ZimmermannEmail author
  • M. Hoffmann
  • T. Laubert
  • H. P. Bruch
  • T. Keck
  • C. Benecke
  • E. Schlöricke
Original Article

Abstract

Purpose

The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals.

Methods

To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care.

Results

Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %.

Conclusions

This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.

Keywords

Laparoscopy Small bowel obstruction Risk analysis Conversion 

Notes

Authors’ contributions

MZ, TK, HPB, and ES contributed to the study conception and design. MZ, HPB, CB, and ES contributed to the acquisition of data. MZ, MH, and TL contributed to the analysis and interpretation of data. MZ, CB, and TK contributed to the drafting of manuscript. MH, TK, ES, and CB contributed to the critical revision of manuscript.

Compliance with ethical standards

Conflict of interest

Drs. M. Zimmermann, M. Hoffmann, T. Laubert, H.-P. Bruch, T. Keck, C. Benecke, and E. Schloericke have no conflicts of interest or financial ties to disclosure.

References

  1. 1.
    Cox MR, Gunn IF, Eastman MC et al (1993) The operative aetiology and types of adhesions causing small bowel obstruction. Aust N Z J Surg 63(11):848–852CrossRefPubMedGoogle Scholar
  2. 2.
    Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 21(11):1945–1949. doi: 10.1007/s00464-007-9575-3 CrossRefPubMedGoogle Scholar
  3. 3.
    Menzies D, Ellis H (1990) Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 72(1):60–63PubMedPubMedCentralGoogle Scholar
  4. 4.
    Tittel A, Treutner KH, Titkova S et al (2001) Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model. Langenbecks Arch Surg 386(2):141–145CrossRefPubMedGoogle Scholar
  5. 5.
    Swank DJ, Hop WC, Jeekel J (2004) Reduction, regrowth, and de novo formation of abdominal adhesions after laparoscopic adhesiolysis: a prospective analysis. Dig Surg 21(1):66–71. doi: 10.1159/000076023 CrossRefPubMedGoogle Scholar
  6. 6.
    Grafen FC, Neuhaus V, Schob O et al (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. doi: 10.1007/s00423-009-0490-z CrossRefPubMedGoogle Scholar
  7. 7.
    Statistisches Bundesamt. Grunddaten der Krankenhäuser 2013 - Fachserie 12 Reihe 6.1.1. Available at: https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/GrunddatenKrankenhaeuser2120611137004.pdf Accessed June 25, 2015.
  8. 8.
    Fincham JE (2008) Response rates and responsiveness for surveys, standards, and the journal. Am J Pharm Educ 72(2):43CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Oyasiji T, Helton SW (2011) Survey of opinions on operative management of adhesive small bowel obstruction: laparoscopy versus laparotomy in the state of Connecticut. Surg Endosc 25(8):2516–2521. doi: 10.1007/s00464-011-1579-3 CrossRefPubMedGoogle Scholar
  10. 10.
    Kelly KN, Iannuzzi JC, Rickles AS et al (2014) Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc 28(1):65–73. doi: 10.1007/s00464-013-3162-6 CrossRefPubMedGoogle Scholar
  11. 11.
    Lombardo S, Baum K, Filho JD et al (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. doi: 10.1097/TA.0000000000000156 CrossRefPubMedGoogle Scholar
  12. 12.
    Saleh F, Ambrosini L, Jackson T et al (2014) Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes. Surgical endoscopy 28(8):2381–2386. doi: 10.1007/s00464-014-3486-x CrossRefPubMedGoogle Scholar
  13. 13.
    Cirocchi R, Abraha I, Farinella E et al (2010) Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev 2:CD007511. doi: 10.1002/14651858.CD007511.pub2 PubMedGoogle Scholar
  14. 14.
    Li M, Lian L, Xiao L et al (2012) Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 204(5):779–786. doi: 10.1016/j.amjsurg.2012.03.005 CrossRefPubMedGoogle Scholar
  15. 15.
    O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc 26(1):12–17. doi: 10.1007/s00464-011-1885-9 CrossRefPubMedGoogle Scholar
  16. 16.
    Davies SW, Gillen JR, Guidry CA et al (2014) A comparative analysis between laparoscopic and open adhesiolysis at a tertiary care center. Am Surg 80(3):261–269PubMedPubMedCentralGoogle Scholar
  17. 17.
    Khaikin M, Schneidereit N, Cera S et al (2007) Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc 21(5):742–746. doi: 10.1007/s00464-007-9212-1 CrossRefPubMedGoogle Scholar
  18. 18.
    Kirshtein B, Roy-Shapira A, Lantsberg L et al (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19(4):464–467. doi: 10.1007/s00464-004-9038-z CrossRefPubMedGoogle Scholar
  19. 19.
    Mathieu X, Thill V, Simoens C et al (2008) Laparoscopic management of acute small bowel obstruction: a retrospective study on 156 patients. Hepatogastroenterology 55(82–83):522–526PubMedGoogle Scholar
  20. 20.
    Suter M, Zermatten P, Halkic N et al (2000) Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Surg Endosc 14(5):478–483CrossRefPubMedGoogle Scholar
  21. 21.
    Willaert W, van de Putte D, van Renterghem K et al (2013) Training models in laparoscopy: a systematic review comparing their effectiveness in learning surgical skills. Acta chirurgica Belgica 113(2):77–95PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • M. Zimmermann
    • 1
    Email author
  • M. Hoffmann
    • 1
  • T. Laubert
    • 1
  • H. P. Bruch
    • 1
  • T. Keck
    • 1
  • C. Benecke
    • 1
  • E. Schlöricke
    • 1
    • 2
  1. 1.Department of SurgeryMedical University Center Schleswig-Holstein Campus LübeckLübeckGermany
  2. 2.Westküstenklinikum Heide, Department of SurgeryHeideGermany

Personalised recommendations