Skip to main content
SpringerLink
Log in

Laparoscopy for acute small bowel obstruction: indication or contraindication?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Al-Mulhim AA (2000) Laparoscopic management of acute small bowel obstruction. Surg Endosc 14:157–160

    Article  CAS  PubMed  Google Scholar 

  2. Hawthorn IE (1992) Abdominal pain as a cause of acute admission to hospital. J R Coll Surg Edinb 37:389–393

    CAS  PubMed  Google Scholar 

  3. Mucha P Jr (1987) Small intestinal obstruction. Surg Clin North Am 67:597–620

    PubMed  Google Scholar 

  4. Ellis H (1982) The causes and prevention of intestinal adhesions. Br J Surg 69:241–243

    Article  CAS  PubMed  Google Scholar 

  5. Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Laparoscopic management of acute small bowel obstruction. Br J Surg 85:84–87

    Article  CAS  PubMed  Google Scholar 

  6. Franklin ME Jr, Gonzalez JJ Jr, Miter DB, Glass JL, Paulson D (2004) Laparoscopic diagnosis and treatment of intestinal obstruction. Surg Endosc 18:26–30

    Article  PubMed  Google Scholar 

  7. Ghosheh B, Salameh J (2007) Laparoscopic approach to acute small bowel obstruction: review of 1,061 cases. Surg Endosc 21:1945–1949

    Article  PubMed  Google Scholar 

  8. Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19:464–467

    Article  CAS  PubMed  Google Scholar 

  9. Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180:33–36

    Article  CAS  PubMed  Google Scholar 

  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 89:407–413

    CAS  PubMed  Google Scholar 

  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 504

    Article  PubMed  Google Scholar 

  12. Kahi CJ, Rex DK (2003) Bowel obstruction and pseudo-obstruction. Gastroenterol Clin North Am 32:1229–1247

    Article  PubMed  Google Scholar 

  13. Dubois F, Icard P, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 211:60–62

    Article  CAS  PubMed  Google Scholar 

  14. Larson GM (1995) Laparoscopy for abdominal emergencies. Scand J Gastroenterol Suppl 208:62–66

    Article  CAS  PubMed  Google Scholar 

  15. Loffer FD, Pent D (1975) Indications, contraindications, and complications of laparoscopy. Obstet Gynecol Surv 30:407–427

    Article  CAS  PubMed  Google Scholar 

  16. Reissman P, Wexner SD (1995) Laparoscopic surgery for intestinal obstruction. Surg Endosc 9:865–868

    CAS  PubMed  Google Scholar 

  17. Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH III (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1:259–262

    Article  CAS  PubMed  Google Scholar 

  18. Chopra R, McVay C, Phillips E, Khalili TM (2003) Laparoscopic lysis of adhesions. Am Surg 69:966–968

    PubMed  Google Scholar 

  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 197:177–181

    Article  PubMed  Google Scholar 

  20. Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906

    Article  CAS  PubMed  Google Scholar 

  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 54:476–479

    Article  CAS  PubMed  Google Scholar 

  22. Ehrmantraut W, Sardi A (1997) Laparoscopy-assisted small bowel resection. Am Surg 63:996–1001

    CAS  PubMed  Google Scholar 

  23. Ellis H (1997) The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl:5–9

    Google Scholar 

  24. van der Zee DC, Bax NM (1999) Management of adhesive bowel obstruction in children is changed by laparoscopy. Surg Endosc 13:925–927

    Article  PubMed  Google Scholar 

  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 81:320–328

    CAS  PubMed  Google Scholar 

  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 42:241–248

    Article  CAS  PubMed  Google Scholar 

  27. Akman PC (1962) A study of five hundred incisional hernias. J Int Coll Surg 37:125–142

    CAS  PubMed  Google Scholar 

  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 343:392–398

    Article  CAS  PubMed  Google Scholar 

  29. Montz FJ, Holschneider CH, Munro MG (1994) Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists. Obstet Gynecol 84:881–884

    CAS  PubMed  Google Scholar 

  30. Szomstein S, Menzo E, Simpfendorfer C, Zundel N, Rosenthal R (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540

    Article  PubMed  Google Scholar 

  31. Franklin ME Jr, Dorman JP, Pharand D (1994) Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 4:289–296

    Article  PubMed  Google Scholar 

  32. Ibrahim IM, Wolodiger F, Sussman B, Kahn M, Silvestri F, Sabar A (1996) Laparoscopic management of acute small-bowel obstruction. Surg Endosc 10:1012–1015

    Article  CAS  PubMed  Google Scholar 

  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 9:283–285

    CAS  PubMed  Google Scholar 

  34. Leon EL, Metzger A, Tsiotos GG, Schlinkert RT, Sarr MG (1998) Laparoscopic management of small bowel obstruction: indications and outcome. J Gastrointest Surg 2:132–140

    Article  CAS  PubMed  Google Scholar 

  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 14:478–483

    Article  CAS  PubMed  Google Scholar 

  36. Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151

    Article  CAS  PubMed  Google Scholar 

  37. Vancaillie TG (1998) Active electrode monitoring: how to prevent unintentional thermal injury associated with monopolar electrosurgery at laparoscopy. Surg Endosc 12:1009–1012

    Article  CAS  PubMed  Google Scholar 

  38. Navez B, Arimont JM, Guiot P (1998) Laparoscopic approach in acute small bowel obstruction: a review of 68 patients. Hepatogastroenterology 45:2146–2150

    CAS  PubMed  Google Scholar 

  39. Nagle A, Ujiki M, Denham W, Murayama K (2004) Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 187:464–470

    Article  PubMed  Google Scholar 

  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 13:695–698

    Article  CAS  PubMed  Google Scholar 

  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 21:742–746

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

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

Author information

Authors and Affiliations

  1. Department of Surgery, Henry Dunant Hospital, 107, Mesogeion Avenue, 115 26, Athens, Greece

    Ioannis Tierris, Constantinos Mavrantonis, Constantinos Stratoulias, George Panousis, Afrodite Mpetsou & Nicolaos Kalochristianakis

  2. 12, Makedonias Street, Agia Paraskevi, 15341, Athens, Greece

    Ioannis Tierris

Authors
  1. Ioannis Tierris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Constantinos Mavrantonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Constantinos Stratoulias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George Panousis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Afrodite Mpetsou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicolaos Kalochristianakis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioannis Tierris.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tierris, I., Mavrantonis, C., Stratoulias, C. et al. Laparoscopy for acute small bowel obstruction: indication or contraindication?. Surg Endosc 25, 531–535 (2011). https://doi.org/10.1007/s00464-010-1206-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1206-8

Keywords

Search

Navigation