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Role of single-incision laparoscopic surgery in the management of small bowel obstruction

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Abstract

Background

Small bowel obstruction (SBO) arises on various backgrounds, and the surgical procedure is often modified intraoperatively as needed. Single-incision laparoscopic surgery (SILS) is less invasive than conventional multiport laparoscopic surgery (MPS) and reported to be equally safe and efficient. We have been applying SILS to SBO requiring surgical treatment, and we conducted a retrospective study to clarify the role of SILS in the management of SBO.

Methods

Thirty-four consecutive patients were identified for inclusion in the study through a review of hospital records of patients having undergone surgery for SBO between May 2013 and June 2018. Patients with tumor- or hernia-related SBO were excluded. We also identified, for comparison, a group of patients who had undergone open surgery for SBO during the preceeding 5-year period. The primary study endpoint was the SILS completion rate, and analyses were performed to identify risk factors for conversion to open surgery and perioperative complications.

Results

The SILS completion rate was 70.6% (24/34 patients), with conversion open surgery required for the remaining 10 (29.4%) patients. Conversion was necessitated by limited working space in 5 (50%) patients, discovery of massive necrosis in 3 (30%), and non-detection of the responsible lesion in 2 (20%). Univariable analysis showed an American Society of Anesthesiologists Physical Status score (p = 0.020) and severe intra-abdominal adhesions (p = 0.007) to be risk factors for conversion. Conversion to open surgery (vs complete SILS) was significantly associated with increased operation time (p = 0.018), blood loss (p = 0.021), postoperative stay (p = 0.010), and postoperative complications (p = 0.004). Open surgery was significantly associated with increased postoperative stay (p = 0.026) and postoperative complications (p = 0.011).

Conclusion

SILS appears to be a reasonable surgical treatment option for selected patients with SBO.

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Acknowledgements

The authors thank Dr. Michitaka Honda of Fukushima Medical University for his advice on statistical issues, and Prof. Tina Tajima of St. Marianna University School of Medicine for her meticulous English editing.

Disclaimer

The present manuscript is an original contribution not previously published and not under consideration for publication elsewhere, and, if accepted, will not be published anywhere in similar form, in any language. All authors have read and approved the manuscript, and the study was approved by the institutional research ethics committee.

Funding

The work described herein was supported by departmental resources only.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan

    Yozo Suzuki, Masahisa Ohtsuka, Manabu Mikamori, Kenta Furukawa, Mitsunobu Imasato, Kentaro Kishi & Hiroki Akamatsu

  2. Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8025, Japan

    Mitsuyoshi Tei & Masaki Wakasugi

  3. Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo, 660-8511, Japan

    Toru Masuzawa

  4. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan

    Takuro Saito

  5. Department of Gastroenterological Surgery, Rinku General Medical Center, 2-23 Rinku Ourai Kita, Izumisano City, Osaka, 598-8577, Japan

    Masahiro Tanemura

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  1. Yozo Suzuki
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Contributions

YS and MT conceived and designed the study, YS, MT, MW, TM, MO, MM, TS, KF, MI, KK, MT and HA acquired data, YS and MT analyzed and interpreted the data, YS and MT drafted the manuscript, MW, TM, MO, MM, TS, KF, MI, KK, MT and HA critically revised the article and MT, MO, MM, TS, KF, MI, KK, MT and HA approved the final version of the manuscript to be published.

Corresponding author

Correspondence to Yozo Suzuki.

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Disclosures

None of the authors, Yozo Suzuki, Mitsuyoshi Tei, Masaki Wakasugi, Toru Masuzawa, Masahisa Ohtsuka, Manabu Mikamori, Takuro Saito, Kenta Furukawa, Mitsunobu Imasato, Kentaro Kishi, Masahiro Tanemura or Hiroki Akamatsu, has a conflict of interest or financial tie to disclose.

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Suzuki, Y., Tei, M., Wakasugi, M. et al. Role of single-incision laparoscopic surgery in the management of small bowel obstruction. Surg Endosc 35, 2558–2565 (2021). https://doi.org/10.1007/s00464-020-07671-9

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