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Adhesive small bowel obstruction: predictive factors of laparoscopic failure

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Abstract

The adoption of laparoscopy for the management of adhesive small bowel obstruction (ASBO) patients is debated. The laparoscopic approach has been associated with a considerable conversion-to-open rate. Nonetheless, reliable predictors of conversion are still unclear. The present study aimed to identify factors associated with conversion to open in ASBO patients who underwent laparoscopic surgery. Patients who underwent laparoscopic surgery for ASBO and were admitted to our unit between December 2014 and October 2022 were retrospectively evaluated. The patients were categorized into two groups: patients who underwent complete laparoscopy approach (Group 1) and patients converted to open technique (Group 2). Demographic, clinical, and radiological features, intraoperative findings, and postoperative outcomes were compared. A total of 168 patients were enrolled: 100 patients (59.5%) were included in Group 1, and 68 patients (40.5%) were included in Group 2. The rate of ischemia (p = 0.023), surgical complications (p = 0.001), operative time (p < 0.0001), days of nasogastric tube maintenance (p < 0.0001), time to canalization (p < 0.0001), and length of hospital stay (p < 0.0001) were significantly higher in Group 2 than Group 1. Following univariate analysis, the presence of feces signs (p = 0.044) and high mean radiodensity of intraperitoneal free fluid (p = 0.031) were significantly associated with Group 2 compared with Group 1. Following multivariate analysis, the feces sign was a significant predictive factor of conversion (OR 1.965 [IC 95%]; p = 0.046). Laparoscopic treatment is a safe and effective approach in patients affected by ASBO. The feces sign may be a predictive factor of conversion and could guide the surgeon in selecting the appropriate management of patients affected by ASBO.

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Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy

    Marta Morelli, Silvia Strambi, Camilla Cremonini, Serena Musetti, Federico Coccolini, Massimo Chiarugi & Dario Tartaglia

  2. Radio-Diagnostic Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy

    Michele Tonerini

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  1. Marta Morelli
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  2. Silvia Strambi
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  4. Serena Musetti
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  5. Michele Tonerini
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  6. Federico Coccolini
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Contributions

MM, SS, and DT: conceptualization, data analysis and writing (original draft); CC, SM and MT: data collection, methodology and data analysis; FC and DT: contributed to conceptualization and revision (editing); MC and DT: supervision.

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Correspondence to Dario Tartaglia.

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Conflict of interest

The authors declare no relevant financial and non-financial interests to disclose. The author MC is an Associate Editor of the Journal.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes, and the retrospective chart review study involving human participants was in accordance with the Helsinki Declaration.

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Informed consent was waived by the local Ethics Committee in view of the retrospective nature of the study.

Research involving human participants and/or animals

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Morelli, M., Strambi, S., Cremonini, C. et al. Adhesive small bowel obstruction: predictive factors of laparoscopic failure. Updates Surg 76, 705–712 (2024). https://doi.org/10.1007/s13304-023-01725-y

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  • DOI: https://doi.org/10.1007/s13304-023-01725-y

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