Early laparoscopic adhesiolysis for small bowel obstruction: retrospective study of main advantages
The problem of managing adhesional small bowel obstruction (ASBO) is still unsolved. A conservative medical attitude is privileged even if it is associated to a high rate of recurrences, while surgery is applied to cases showing no improvement after 48–72 h. Adhesiolysis via laparotomy has been the standard surgical management, but it causes other adhesions in a vicious circle. The aim of the study is to evaluate the advantages of early laparoscopic adhesiolysis as an alternative approach.
From January 2010 to April 2017, 107 patients were admitted with a diagnosis of ASBO. Patients underwent medical treatment, early surgery, emergency surgery or delayed surgery after failure of medical treatment. A retrospective review and explorative statistical analysis were performed using graphical diagnostic plots, Mann–Whitney (MW) test, Kolmogorov–Smirnov (KS) test, exact binomial test, and χ 2 test.
Medical treatment led to resolution in the 77.3% of cases, but patients exhibit much more recurrences than those in the surgical group (χ 2 p < .001). They also show a longer fasting time (MW p = .027; KS p = .102), a doubled number of radiological exams (MW p < .001; KS p < .001), and more major complications than those in the early surgery group. Early surgery group is associated to shorter fasting time (MW p < .001; KS p < .001), much shorter hospital stay (MW p < .001; KS p = .002) and a smaller number of radiological exams (MW p = .005; KS p = .002) compared with delayed surgery group. The laparoscopic group shows significantly earlier regain of intestinal transit (MW p < .001; KS p = .002), shorter fasting time (MW p = .002; KS p = .008), reduced number of radiological exams (MW p = .003; KS p = .014), reduced hospital stay (MW p < .001; KS p = .005), and no more complications than the open surgery group.
Early laparoscopic surgery can be proposed as an effective alternative treatment for ASBO.
KeywordsSmall bowel obstruction Laparoscopic adhesiolysis Postoperative adherence formation Management of small bowel adherences Early adhesiolysis Obstruction recurrences
Compliance with ethical standards
Claudia Hannele Mazzetti, Francesco Serinaldi, Eric Lebrun, and Jean Lemaitre have no conflicts of interest or financial ties to disclose.
- 2.Holmdahl L, Risberg B, Beck DE et al (1997) Adhesions: pathogenesis and prevention-panel discussion and summary. Eur J Surg Suppl 557:56–62Google Scholar
- 5.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 244:750–757CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C et al (2013) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 8:42CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M et al (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 6:5CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Mouret P L’adesiolisi coelioscopia. Chirurgia digestiva per via coelioscopica. (1994) In: Testa P, Delaitre B (eds) Edizioni Vigot, Friburgo, pp. 53–69Google Scholar
- 26.Pei KY, Asuzu D, Davis KA (2017) Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database. Surg Endosc 31:2180–2186CrossRefPubMedGoogle Scholar
- 32.R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria, (2016). Available at: http://www.R-project.org/, Accessed January 6, 2017