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Surgical Endoscopy

, Volume 24, Issue 4, pp 792–797 | Cite as

Laparoscopy for small bowel obstruction: the reason for conversion matters

  • D. Dindo
  • M. Schafer
  • M. K. Muller
  • P.-A. Clavien
  • D. HahnloserEmail author
Article

Abstract

Background

Although laparoscopy is associated with reduced hospital stay, early recovery, and decreased morbidity compared with open surgery, it is not well established for the treatment of small bowel obstruction (SBO).

Methods

This study analyzed a prospective nationwide database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery.

Results

From 1995 to 2006, 537 patients underwent laparoscopy for SBO. Matted adhesions were the main cause of obstruction (62.6%). Intraoperative complications occurred for 9.5% of the patients. Postoperative morbidity was 14% and mortality 0.6%. Within 30 days, 13 patients (2.4%) were readmitted because of early recurrence or complications. The conversion rate was 32.4%. The conversions resulted from inability to visualize the site of obstruction or matted adhesions (53.4%), intraoperative complications (21.3%), and small target incisions for resection (25.3%). Emergency operations were associated with higher conversion rates (43.6% vs 19.8%; p < 0.001) but not with significantly more postoperative complications (15.2% vs 11.9%; p = 0.17). Intraoperative complications and conversion were associated with significantly increased postoperative morbidity (39.2% vs 11.3%; p < 0.001 and 24.7% vs 8.3%; p < 0.001, respectively). Reactive conversion due to intraoperative complications was associated with the highest postoperative complication rate (48.6%). Morbidity for preemptive conversion due to impaired visualization/matted adhesions or a small-target incision was significantly lower (20% and 26.1%; p = 0.02 and p < 0.001, respectively). American Society of Anesthesiology (ASA) scores higher than 2 also were associated with postoperative morbidity (p < 0.001). However, multivariate regression analysis showed that reactive conversion was the only independent risk factor for postoperative morbidity (p < 0.001; odds ratio, 3.97; 95% confidence interval, 1.83–8.64).

Conclusions

Laparoscopic management of SBO is feasible with acceptable morbidity and low mortality but with a considerable conversion rate. Early conversion is recommended to reduce postoperative morbidity.

Keywords

Laparoscopy Small bowel obstruction 

References

  1. 1.
    Menzies D, Ellis H (1990) Intestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl 72:60–63PubMedGoogle Scholar
  2. 2.
    Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, Nogueras JJ, Vernava AMIII, Wexner SD (2007) Laparoscopic vs open surgery for acute adhesive small bowel obstruction: patients’ outcome and cost effectiveness. Surg Endosc 21:742–746CrossRefPubMedGoogle Scholar
  3. 3.
    Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540CrossRefPubMedGoogle Scholar
  4. 4.
    Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1, 061 cases. Surg Endosc 21:1945–1949CrossRefPubMedGoogle Scholar
  5. 5.
    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 14:478–483CrossRefPubMedGoogle Scholar
  6. 6.
    Levard H, Boudet MJ, Msika S, Molkhou JM, Hay JM, Laborde Y, Gillet M, Fingerhut A (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71:641–646CrossRefPubMedGoogle Scholar
  7. 7.
    Mucha P Jr (1987) Small intestinal obstruction. Surg Clin North Am 67:597–620PubMedGoogle Scholar
  8. 8.
    Garrard CL, Clements RH, Nanney L, Davidson JM, Richards WO (1999) Adhesion formation is reduced after laparoscopic surgery. Surg Endosc 13:10–13CrossRefPubMedGoogle Scholar
  9. 9.
    Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906CrossRefPubMedGoogle Scholar
  10. 10.
    Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181CrossRefPubMedGoogle Scholar
  11. 11.
    Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151CrossRefPubMedGoogle Scholar
  12. 12.
    Chosidow D, Johanet H, Montariol T, Kielt R, Manceau C, Marmuse JP, Benhamou G (2000) Laparoscopy for acute small-bowel obstruction secondary to adhesions. J Laparoendosc Adv Surg Tech A 10:155–159CrossRefPubMedGoogle Scholar
  13. 13.
    Al-Mulhim AA (2000) Laparoscopic management of acute small bowel obstruction: experience from a Saudi teaching hospital. Surg Endosc 14:157–160CrossRefPubMedGoogle Scholar
  14. 14.
    Strickland P, Lourie DJ, Suddleson EA, Blitz JB, Stain SC (1999) Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 13:695–698CrossRefPubMedGoogle Scholar
  15. 15.
    Navez B, Arimont JM, Guiot P (1998) Laparoscopic approach in acute small bowel obstruction: a review of 68 patients. Hepatogastroenterology 45:2146–2150PubMedGoogle Scholar
  16. 16.
    Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19:464–467CrossRefPubMedGoogle Scholar
  17. 17.
    Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT (2007) The laparoscopic management of small-bowel obstruction. Am J Surg 194:882–887 discussion 887–888CrossRefPubMedGoogle Scholar
  18. 18.
    Chopra R, McVay C, Phillips E, Khalili TM (2003) Laparoscopic lysis of adhesions. Am Surg 69:966–968PubMedGoogle Scholar
  19. 19.
    Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Laparoscopic management of acute small bowel obstruction. Br J Surg 85:84–87CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • D. Dindo
    • 1
  • M. Schafer
    • 1
  • M. K. Muller
    • 1
  • P.-A. Clavien
    • 1
  • D. Hahnloser
    • 1
    Email author
  1. 1.Department of Surgery, Division of Visceral and Transplantation SurgeryUniversity HospitalZurichSwitzerland

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