Surgical Endoscopy

, Volume 26, Issue 1, pp 12–17 | Cite as

The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases

  • Donal B. O’ConnorEmail author
  • Desmond C. Winter



Adhesive small-bowel obstruction (SBO) contributes significantly to emergency surgical workload. Laparotomy remains the standard approach. Despite published reports with high success rates and low morbidity, acute SBO is still considered by many a relative contraindication to laparoscopy. Our aim was to review the available literature and define important outcomes such as feasibility, safety, iatrogenic bowel injury, and benefits to patients with acute SBO who are approached laparoscopically.


A systematic literature search was carried out using the Medline database and the search terms “laparoscopy” or “laparoscopic approach” and “bowel obstruction.” Only adult studies published in English between 1990 and 2010 were included. Studies were excluded if data specific to outcomes for laparoscopic management of acute SBO could not be extracted.


Twenty-nine studies were identified. A laparoscopic approach was attempted in 2,005 patients with acute SBO. Adhesions were the most common etiology (84.9%). Laparoscopy was completed in 1,284 cases (64%), 6.7% were lap-assisted, and 0.3% were converted to hernia repair. The overall conversion rate to midline laparotomy was 29% (580/2,005). Dense adhesions, bowel resection, unidentified pathology, and iatrogenic injury accounted for the majority of conversions. When the etiology of SBO was a single-band adhesion, the success rate was 73.4%. Morbidity was 14.8% (283/1,906) and mortality was 1.5% (29/1,951). The enterotomy rate was 6.6% (110/1,673). The majority were recognized and converted to laparotomy. Laparoscopy was associated with reduced morbidity and length of stay.


Laparoscopy is a feasible and effective treatment for acute SBO with acceptable morbidity. Further studies are required to determine its impact on recurrent SBO.


Bowel Abdominal A&E Complications Adhesions Surgical 



Donal B. O’Connor and Desmond C. Winter have no conflicts of interest or financial ties to disclose.


  1. 1.
    Franklin ME Jr, Dorman JP, Pharand D (1994) Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 4:289–296PubMedCrossRefGoogle Scholar
  2. 2.
    Ibrahim IM, Wolodiger F, Sussman B, Kahn M, Silvestri F, Sabar A (1996) Laparoscopic management of acute small-bowel obstruction. Surg Endosc 10:1012–1014PubMedCrossRefGoogle Scholar
  3. 3.
    Bailey IS, Rhodes M, O’ Rourke N, Nathanson L, Fielding G (1998) Laparoscopic management of acute small bowel obstruction. Br J Surg 85:84–87PubMedCrossRefGoogle Scholar
  4. 4.
    Navez B, Arimont JM, Guiot P (1998) Laparoscopic approach in acute small bowel obstruction. A review of 68 patients. Hepatogastroenterology 45:2146–2150PubMedGoogle Scholar
  5. 5.
    El Dahha AA, Shawkat AM, Bakr AAA (1999) Laparoscopic adhesiolysis in acute small bowel obstruction: a preliminary experience. JSLS 3:131–135PubMedGoogle Scholar
  6. 6.
    Strickland P, Louie DJ, Suddleson EA, Blitz JB, Stain SC (1999) Is laparoscopy safe and effective for the treatment of acute small bowel obstruction? Surg Endosc 13:695–698PubMedCrossRefGoogle Scholar
  7. 7.
    Rosin D, Kuriansky J, Bar Zakai B, Shabtai M, Ayalon A (2000) Laparoscopic approach to small bowel obstruction. J Laparoendosc Adv Surg Tech A 10:253–257PubMedCrossRefGoogle Scholar
  8. 8.
    Al-Mulhim AA (2000) Laparoscopic management of acute small bowel obstruction. Experience from a Saudi teaching hospital. Surg Endosc 14:157–160PubMedCrossRefGoogle Scholar
  9. 9.
    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 10:155–159PubMedCrossRefGoogle Scholar
  10. 10.
    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 14:478–483PubMedCrossRefGoogle Scholar
  11. 11.
    Agresta F, Piazza A, Michelet I, Bedin N, Sartori CA (2000) Small bowel obstruction. Laparoscopic approach. Surg Endosc 14:154–156PubMedCrossRefGoogle Scholar
  12. 12.
    Sato Y, Ido K, Kumagai M, Isoda N, Hozumi M, Nagamine N, Ono K, Shibusawa H, Togashi K, Sugano K (2000) Laparoscopic adhesiolysis for recurrent small bowel obstruction: long-term follow-up. Gastrointest Endosc 54:476–479CrossRefGoogle Scholar
  13. 13.
    Levard H, Boudet MJ, Msika S, Molkhou JM, Hay JM, Laborde Y, Gillet M, Fingerhut A, French Association for Surgical Research (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71:641–646PubMedCrossRefGoogle Scholar
  14. 14.
    Chopra R, McVay C, Phillips E, Khalili TM (2003) Laparoscopic lysis of adhesions. Am Surg 69:966–968PubMedGoogle Scholar
  15. 15.
    Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151PubMedCrossRefGoogle Scholar
  16. 16.
    Suzuki K, Umehara Y, Kimura T (2003) Elective laparoscopy for small bowel obstruction. Surg Laparosc Endosc Percutan Tech 13:254–256PubMedCrossRefGoogle Scholar
  17. 17.
    Borzellino G, Tasselli S, Zerman G, Pedrazzani C, Manzoni G (2004) Laparoscopic approach to postoperative adhesive obstruction. Surg Endosc 18:686–690PubMedCrossRefGoogle Scholar
  18. 18.
    Liauw J, Cheah WK (2005) Laparoscopic management of acute small bowel obstruction. Asian J Surg 28:185–188PubMedCrossRefGoogle Scholar
  19. 19.
    Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19:464–467PubMedCrossRefGoogle Scholar
  20. 20.
    Lujan HJ, Oren A, Plasencia G, Canelon G, Gomez E, Hernandez-Cano A, Jacobs M (2006) Laparoscopic management as the initial treatment of acute small bowel obstruction. JSLS 10:466–472PubMedGoogle Scholar
  21. 21.
    Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, Nogueras JJ, Vernava AM III, Wexner SD (2007) Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc 21:742–746PubMedCrossRefGoogle Scholar
  22. 22.
    Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT (2007) The laparoscopic management of small-bowel obstruction. Am J Surg 194:882–888PubMedCrossRefGoogle Scholar
  23. 23.
    Mathieu X, Thill V, Simoens CH, Smets D, Ngongang CH, Debergh N, da Costa PM (2008) Laparoscopic management of acute small bowel obstruction: a retrospective study on 156 patients. Hepatogastroenterology 55:522–526PubMedGoogle Scholar
  24. 24.
    Pearl JP, Marks JM, Hardacre JM, Ponsky JL, Delaney CP, Rosen MJ (2008) Laparoscopic treatment of complex small bowel obstruction: is it safe? Surg Innov 15:110–113PubMedCrossRefGoogle Scholar
  25. 25.
    Agresta F, Mazzarolo G, Ciardo LF, Bedin N (2008) The laparoscopic approach in abdominal emergencies: has the attitude changed? A single-centre review of a 15-year experience. Surg Endosc 22:1255–1262PubMedCrossRefGoogle Scholar
  26. 26.
    Lee IK, Kim do H, Gorden DL, Lee YS, Jung SE, Oh ST, Kim JG, Jeon HM, Kim EK, Chang SK (2009) Selective laparoscopic management of adhesive small bowel obstruction using CT guidance. Am Surg 75:227–231PubMedGoogle Scholar
  27. 27.
    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 395:57–63PubMedCrossRefGoogle Scholar
  28. 28.
    Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D (2009) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24:793–797Google Scholar
  29. 29.
    Tierris I, Mavrantonis C, Stratoulias C, Panousis G, Mpetsou A, Kalochristianakis N (2011) Laparoscopy for acute small bowel obstruction: indication or contraindication? Surg Endosc 25:531–535PubMedCrossRefGoogle Scholar
  30. 30.
    Kössi J, Salminen P, Rantala A, Lato M (2003) Population-based study of the surgical workload and economic impact of bowel obstruction cause by postoperative adhesions. Br J Surg 90:1441–1444PubMedCrossRefGoogle Scholar
  31. 31.
    Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480PubMedCrossRefGoogle Scholar
  32. 32.
    Sauerland S, Lefering R, Neugebauer EA (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev (4):CD001546Google Scholar
  33. 33.
    Lau WY, Leung KL, Kwong KH, Davey IC, Robertson C, Dawson JJ, Chung SC, Li AK (1996) A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 224:131–138PubMedCrossRefGoogle Scholar
  34. 34.
    Lesperance K, Martin MJ, Lehmann R, Brounts L, Steele SR (2009) National trends and outcomes for the surgical therapy of ileocolonic Crohn’s disease: a population-based analysis of laparoscopic vs. open approaches. J Gastrointest Surg 13:1251–1259PubMedCrossRefGoogle Scholar
  35. 35.
    Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH III (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1:259–262PubMedCrossRefGoogle Scholar
  36. 36.
    Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29PubMedCrossRefGoogle Scholar
  37. 37.
    Mancini GJ, Petroski GF, Lin WC, 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 207:520–526PubMedCrossRefGoogle Scholar
  38. 38.
    Asbun HJ, Pempinello C, Halasz NA (1989) Small bowel obstruction and its management. Int Surg 74:23–27PubMedGoogle Scholar
  39. 39.
    Williams SB, Greenspon J, Young HA, Orkin BA (2005) Small bowel obstruction: conservative versus surgical management. Dis Colon Rectum 48:1140–1146PubMedCrossRefGoogle Scholar
  40. 40.
    Fevang BT, Fevang J, Lie SA, Søreide O, Svanes K, Viste A (2004) Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 20:193–201CrossRefGoogle Scholar
  41. 41.
    Duron JJ, Silva NJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M, Hay JM (2006) Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study. Ann Surg 24:750–757CrossRefGoogle Scholar
  42. 42.
    Menzies D, Ellis H (1990) Intestinal obstruction from adhesions: How big is the problem? Ann R Coll Surg Eng 72:60–63Google Scholar
  43. 43.
    Leung TT, Dixon E, Gill M, Moulton KM, Kaplan GG, MacLean AR (2009) Bowel obstruction following appendectomy: what is the true incidence? Ann Surg 250:51–53PubMedCrossRefGoogle Scholar
  44. 44.
    Ziprin P, Ridgway PF, Peck DH, Darzi AW (2003) Laparoscopic-type environment enhances mesothelial cell fibrinolytic activity in vitro via a down-regulation of plasminogen activator inhibitor-1 activity. Surgery 134:758–765PubMedCrossRefGoogle Scholar
  45. 45.
    Tittel A, Treutner KH, Titkova S, Ottinger A, Schumpelick V (2001) New adhesion formation after laparoscopic and conventional adhesiolysis: a comparative study in the rabbit. Surg Endosc 15:44–46PubMedCrossRefGoogle Scholar
  46. 46.
    Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA (2008) Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg 95:909–914PubMedCrossRefGoogle Scholar
  47. 47.
    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 197:177–181PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Surgery, Institute for Clinical Outcomes Research and Education, St Vincent’s University HospitalUniversity College DublinDublinIreland
  2. 2.Education and Research CentreSt Vincent’s University HospitalDublin 4 Ireland

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