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Surgical Endoscopy

, Volume 25, Issue 2, pp 531–535 | Cite as

Laparoscopy for acute small bowel obstruction: indication or contraindication?

  • Ioannis TierrisEmail author
  • Constantinos Mavrantonis
  • Constantinos Stratoulias
  • George Panousis
  • Afrodite Mpetsou
  • Nicolaos Kalochristianakis
Article

Abstract

Background

Acute small bowel obstruction (SBO) is a relatively common cause of emergency hospital admission, most frequently due to postoperative adhesions. With increased experience and technical advances in laparoscopic surgery, the laparoscopic management of acute SBO has become feasible and potentially superior to the open approach. This retrospective study presents the authors’ experience with laparoscopic treatment of SBO over a 6-year period to assess the feasibility, efficacy, and clinical outcome of this therapeutic method and to present the author’s methodology.

Methods

From April 2003 to January 2009, 32 patients hospitalized in the author’s department for acute SBO underwent elective laparoscopic treatment after failure of conservative measures. Standard laparoscopic techniques and instruments were used.

Results

Postoperative adhesions were identified in 62.5% of patients (n = 20) as well as tumor (n = 3), incarcerated ventral hernia (n = 4), incarcerated femoral hernia (n = 3), internal hernia (n = 1), and Crohn’s disease (n = 1). The conversion rate was 18.7% (n = 6), and the postoperative complication rate was 3.25% (n = 1). The mean operative time was 78 min. Bowel function returned after a mean of 3.2 days, and the mean hospital stay was 4.6 days.

Conclusions

The laparoscopic treatment of acute SBO is an attractive alternative to the open approach. However, it must be kept in mind that surgery longer than 120 min is a significant predictor of postoperative morbidity, that bowel injury may be missed at the time of operation and can be avoided with improved surgical techniques and appropriate instrumentation, that lysis of all intraabdominal adhesions is unnecessary, and that a low threshold for conversion should be maintained, especially in cases of severe, dense, extensive adhesions.

Keywords

Complications Indications Laparoscopy Small bowel obstruction 

Notes

Disclosures

Ioannis Tierris, Constantinos Mavrantonis, Constantinos Stratoulias, George Panousis, Afrodite Mpetsou, and Nicolaos Kalochristianakis have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Al-Mulhim AA (2000) Laparoscopic management of acute small bowel obstruction. Surg Endosc 14:157–160CrossRefPubMedGoogle Scholar
  2. 2.
    Hawthorn IE (1992) Abdominal pain as a cause of acute admission to hospital. J R Coll Surg Edinb 37:389–393PubMedGoogle Scholar
  3. 3.
    Mucha P Jr (1987) Small intestinal obstruction. Surg Clin North Am 67:597–620PubMedGoogle Scholar
  4. 4.
    Ellis H (1982) The causes and prevention of intestinal adhesions. Br J Surg 69:241–243CrossRefPubMedGoogle Scholar
  5. 5.
    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
  6. 6.
    Franklin ME Jr, Gonzalez JJ Jr, Miter DB, Glass JL, Paulson D (2004) Laparoscopic diagnosis and treatment of intestinal obstruction. Surg Endosc 18:26–30CrossRefPubMedGoogle Scholar
  7. 7.
    Ghosheh B, Salameh J (2007) Laparoscopic approach to acute small bowel obstruction: review of 1,061 cases. Surg Endosc 21:1945–1949CrossRefPubMedGoogle Scholar
  8. 8.
    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
  9. 9.
    Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180:33–36CrossRefPubMedGoogle Scholar
  10. 10.
    Bizer LS, Liebling RW, Delany HM, Gliedman ML (1981) Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery 89:407–413PubMedGoogle Scholar
  11. 11.
    Harris EA, Kelly AW, Pockaj BA, Heppell J, Hentz JG, Kelly KA (2002) Reoperation on the abdomen encased in adhesions. Am J Surg 184:499–504 discussion 504CrossRefPubMedGoogle Scholar
  12. 12.
    Kahi CJ, Rex DK (2003) Bowel obstruction and pseudo-obstruction. Gastroenterol Clin North Am 32:1229–1247CrossRefPubMedGoogle Scholar
  13. 13.
    Dubois F, Icard P, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 211:60–62CrossRefPubMedGoogle Scholar
  14. 14.
    Larson GM (1995) Laparoscopy for abdominal emergencies. Scand J Gastroenterol Suppl 208:62–66CrossRefPubMedGoogle Scholar
  15. 15.
    Loffer FD, Pent D (1975) Indications, contraindications, and complications of laparoscopy. Obstet Gynecol Surv 30:407–427CrossRefPubMedGoogle Scholar
  16. 16.
    Reissman P, Wexner SD (1995) Laparoscopic surgery for intestinal obstruction. Surg Endosc 9:865–868PubMedGoogle Scholar
  17. 17.
    Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH III (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1:259–262CrossRefPubMedGoogle Scholar
  18. 18.
    Chopra R, McVay C, Phillips E, Khalili TM (2003) Laparoscopic lysis of adhesions. Am Surg 69:966–968PubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906CrossRefPubMedGoogle Scholar
  21. 21.
    Sato Y, Ido K, Kumagai M, Isoda N, Hozumi M, Nagamine N, Ono K, Shibusawa H, Togashi K, Sugano K (2001) Laparoscopic adhesiolysis for recurrent small bowel obstruction: long-term follow-up. Gastrointest Endosc 54:476–479CrossRefPubMedGoogle Scholar
  22. 22.
    Ehrmantraut W, Sardi A (1997) Laparoscopy-assisted small bowel resection. Am Surg 63:996–1001PubMedGoogle Scholar
  23. 23.
    Ellis H (1997) The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl:5–9Google Scholar
  24. 24.
    van der Zee DC, Bax NM (1999) Management of adhesive bowel obstruction in children is changed by laparoscopy. Surg Endosc 13:925–927CrossRefPubMedGoogle Scholar
  25. 25.
    Wilson MS, Ellis H, Menzies D, Moran BJ, Parker MC, Thompson JN (1999) A review of the management of small bowel obstruction. Members of the Surgical and Clinical Adhesions Research Study (SCAR). Ann R Coll Surg Engl 81:320–328PubMedGoogle Scholar
  26. 26.
    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 42:241–248CrossRefPubMedGoogle Scholar
  27. 27.
    Akman PC (1962) A study of five hundred incisional hernias. J Int Coll Surg 37:125–142PubMedGoogle Scholar
  28. 28.
    Luijendijk RW, Hop WCJ, van den Tol MP, de Lange DCD, Braaksma MMJ, IJzermans JNM, Boelhouwer RU, de Vries BC, Salu MKM, Wereldsma JCJ, Bruijninckx CMA, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398CrossRefPubMedGoogle Scholar
  29. 29.
    Montz FJ, Holschneider CH, Munro MG (1994) Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists. Obstet Gynecol 84:881–884PubMedGoogle Scholar
  30. 30.
    Szomstein S, Menzo E, Simpfendorfer C, Zundel N, Rosenthal R (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540CrossRefPubMedGoogle Scholar
  31. 31.
    Franklin ME Jr, Dorman JP, Pharand D (1994) Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 4:289–296CrossRefPubMedGoogle Scholar
  32. 32.
    Ibrahim IM, Wolodiger F, Sussman B, Kahn M, Silvestri F, Sabar A (1996) Laparoscopic management of acute small-bowel obstruction. Surg Endosc 10:1012–1015CrossRefPubMedGoogle Scholar
  33. 33.
    Caprini JA, Arcelus JA, Swanson J, Coats R, Hoffman K, Brosnan JJ, Blattner S (1995) The ultrasonic localization of abdominal wall adhesions. Surg Endosc 9:283–285PubMedGoogle Scholar
  34. 34.
    Leon EL, Metzger A, Tsiotos GG, Schlinkert RT, Sarr MG (1998) Laparoscopic management of small bowel obstruction: indications and outcome. J Gastrointest Surg 2:132–140CrossRefPubMedGoogle Scholar
  35. 35.
    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
  36. 36.
    Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151CrossRefPubMedGoogle Scholar
  37. 37.
    Vancaillie TG (1998) Active electrode monitoring: how to prevent unintentional thermal injury associated with monopolar electrosurgery at laparoscopy. Surg Endosc 12:1009–1012CrossRefPubMedGoogle Scholar
  38. 38.
    Navez B, Arimont JM, Guiot P (1998) Laparoscopic approach in acute small bowel obstruction: a review of 68 patients. Hepatogastroenterology 45:2146–2150PubMedGoogle Scholar
  39. 39.
    Nagle A, Ujiki M, Denham W, Murayama K (2004) Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 187:464–470CrossRefPubMedGoogle Scholar
  40. 40.
    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
  41. 41.
    Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss E, Nogueras J, Vernava A, Wexner S (2007) Laparoscopic vs. open surgery for acute adhesive small bowel obstruction: patients’ outcome and cost effectiveness. Surg Endosc 21:742–746CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ioannis Tierris
    • 1
    • 2
    Email author
  • Constantinos Mavrantonis
    • 1
  • Constantinos Stratoulias
    • 1
  • George Panousis
    • 1
  • Afrodite Mpetsou
    • 1
  • Nicolaos Kalochristianakis
    • 1
  1. 1.Department of SurgeryHenry Dunant HospitalAthensGreece
  2. 2.AthensGreece

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