Surgical Endoscopy

, Volume 32, Issue 12, pp 4900–4911 | Cite as

Comparison of outcomes following laparoscopic and open treatment of emergent small bowel obstruction: an 11-year analysis of ACS NSQIP

  • Richa Patel
  • Neil P. Borad
  • Aziz M. MerchantEmail author



Small bowel obstruction (SBO) continues to be a common indication for acute care surgery. While open procedures are still widely used for treatment, laparoscopic procedures may have important advantages in certain patient populations. We aim to analyze differences in outcomes between the two for treatment of bowel obstruction.


The American College of Surgeons National Surgical Quality Improvement Program was used to find patients that underwent emergent or non-elective surgery for SBO. Propensity matching was used to create comparable groups. Logistic regression was used to assess differences in the primary outcome of interest, return to operating room, and morbidity and mortality outcomes. Logistic regression was also used to assess the contribution of various preoperative demographic and comorbidity characteristics to 30-day mortality.


A total of 24,028 patients underwent surgery for SBO from 2005 to 2011. Of those, 3391 were laparoscopic. Propensity matching resulted in 6782 matched patients. Laparoscopic cases had significantly decreased odds of experiencing any morbidity and wound complications compared to open cases in bowel-resection and adhesiolysis-only cases. There was no significant difference found for odds of returning to operating room. Laparoscopic cases resulted in significantly shorter hospital stays than open cases (7.18 vs.10.84 days, p < 0.0001). Increasing age, American Society of Anesthesiologists class greater than three, and the presence of respiratory comorbidities resulted in increased odds of mortality. Underweight body mass index (BMI) (< 18.5) increased odds of mortality while greater than normal BMI (> 25) decreased odds of mortality.


Analysis of emergent SBO cases between 2005 and 2015 demonstrates that laparoscopy is not utilized as often as open approaches in surgical treatment. Laparoscopic surgery resulted in reduced postoperative morbidity and significantly shorter hospital stays compared to open intervention and was not associated with significant differences in odds of reoperation compared to open surgery.


Small bowel obstruction Laparoscopic surgery Propensity score matching NSQIP Regression modeling 


Compliance with ethical standards


Richa Patel, Neil Borad, and Dr. Aziz Merchant have no conflicts of interest or financial disclosures to disclose.


  1. 1.
    Coe TM, Chang DC, Sicklick JK (2015) Small bowel volvulus in the adult populace of the United States: results from a population-based study. Am J Surg 210:201–210. e2CrossRefGoogle Scholar
  2. 2.
    Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM (2016) Use of national burden to define operative emergency general surgery. JAMA Surg 151:e160480CrossRefGoogle Scholar
  3. 3.
    Kelly KN, Iannuzzi JC, Rickles AS, Garimella V, Monson JR, Fleming FJ (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 28:65–73CrossRefGoogle Scholar
  4. 4.
    Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the World Society of Emergency Surgery. World J Emerg Surg 6:21CrossRefGoogle Scholar
  5. 5.
    Gutt CN, Oniu T, Schemmer P, Mehrabi A, Büchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906CrossRefGoogle Scholar
  6. 6.
    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 76:696–703CrossRefGoogle Scholar
  7. 7.
    Daly SC, Popoff AM, Fogg L, Francescatti AB, Myers JA, Millikan KW, Deziel DJ, Luu MB (2014) Minimally invasive technique leads to decreased morbidity and mortality in small bowel resections compared to an open technique: an ACS-NSQIP identified target for improvement. J Gastrointest Surg 18:1171–1175CrossRefGoogle Scholar
  8. 8.
    Sharma R, Reddy S, Thoman D, Grotts J, Ferrigno L (2015) Laparoscopic versus open bowel resection in emergency small bowel obstruction: analysis of the national surgical quality improvement program database. J Laparoendosc Adv Surg Tech A 25:625–630CrossRefGoogle Scholar
  9. 9.
    Behman R, Nathens AB, Byrne JP, Mason S, Look Hong N, Karanicolas PJ (2017) Laparoscopic surgery for adhesive small bowel obstruction is associated with a higher risk of bowel injury: a population-based analysis of 8584 patients. Ann Surg 266:489–498CrossRefGoogle Scholar
  10. 10.
    O’Connor DB, Winter DC (2010) Bowel obstruction following appendectomy: a protective role implied for laparoscopy? Ann Surg 251:1190–1191CrossRefGoogle Scholar
  11. 11.
    Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 21:1945–1949CrossRefGoogle Scholar
  12. 12.
    Fuchshuber PR, Greif W, Tidwell CR, Klemm MS, Frydel C, Wali A, Rosas E, Clopp MP (2012) The power of the National Surgical Quality Improvement Program–achieving a zero pneumonia rate in general surgery patients. Perm J 16:39–45CrossRefGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  14. 14.
    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 207:520–526CrossRefGoogle Scholar
  15. 15.
    Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151CrossRefGoogle Scholar
  16. 16.
    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 72:25–30CrossRefGoogle Scholar
  17. 17.
    Li MZ, Lian L, Xiao LB, Wu WH, He YL, Song XM (2012) Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 204:779–786CrossRefGoogle Scholar
  18. 18.
    Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A (2015) Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 29:2525–2532CrossRefGoogle Scholar
  19. 19.
    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 72:25–31,317CrossRefGoogle Scholar
  20. 20.
    Davies SW, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T, Sawyer RG, Hallowell PT (2014) A comparative analysis between laparoscopic and open adhesiolysis at a tertiary care center. Am Surg 80:261–269PubMedPubMedCentralGoogle Scholar
  21. 21.
    Grafen FC, Neuhaus V, Schob 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 395:57–63CrossRefGoogle Scholar
  22. 22.
    Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, Nogueras JJ, Vernava AM 3rd, Wexner SD (2007) Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc 21:742–746CrossRefGoogle Scholar
  23. 23.
    Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, Henderson WG, Khuri SF (2006) Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 243:456–464CrossRefGoogle Scholar
  24. 24.
    Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK (2016) A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg 212:138–150CrossRefGoogle Scholar
  25. 25.
    Al-Temimi MH, Griffee M, Enniss TM, Preston R, Vargo D, Overton S, Kimball E, Barton R, Nirula R (2012) When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 215:503–511CrossRefGoogle Scholar
  26. 26.
    Symons NR, Moorthy K, Almoudaris AM, Bottle A, Aylin P, Vincent CA, Faiz OD (2013) Mortality in high-risk emergency general surgical admissions. Br J Surg 100:1318–1325CrossRefGoogle Scholar
  27. 27.
    Jeppesen MH, Tolstrup MB, Kehlet Watt S, Gogenur I (2016) Risk factors affecting morbidity and mortality following emergency laparotomy for small bowel obstruction: a retrospective cohort study. Int J Surg 28:63–68CrossRefGoogle Scholar
  28. 28.
    Hamaguchi S et al (2010) Body mass index is an independent predictor of long-term outcomes in patients hospitalized with heart failure in Japan. Circ J 74(12):2605–2611CrossRefGoogle Scholar
  29. 29.
    Schiffmann J et al (2018) Obesity paradox in prostate cancer: increased body mass index was associated with decreased risk of metastases after surgery in 13,667 patients. World J Urol. CrossRefPubMedGoogle Scholar
  30. 30.
    Zhang JC et al (2018) Can patient selection explain the obesity paradox in orthopaedic hip surgery? An analysis of the ACS-NSQIP registry. Clin Orthop Relat Res 476(5):964–973CrossRefGoogle Scholar
  31. 31.
    Park J et al (2014) Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis 56(4):415–425CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Richa Patel
    • 1
  • Neil P. Borad
    • 1
  • Aziz M. Merchant
    • 1
    • 2
    Email author
  1. 1.Department of Surgery, New Jersey Medical SchoolRutgers UniversityNewarkUSA
  2. 2.Department of Surgery, New Jersey Medical SchoolRutgers UniversityNewarkUSA

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