The Role of Laparoscopy in the Management of Bowel Obstruction

  • Angela H. KuhnenEmail author


Though laparotomy is the traditional intervention for adhesive small bowel obstruction (SBO), laparoscopy is becoming increasingly accepted and utilized and offers patient advantages in selected cases. Patient history and preoperative imaging are often helpful in determining if the patient is a candidate for a laparoscopic approach. During laparoscopic exploration, initial peritoneal access should be attained away from prior scars, and the bowel should ideally be examined from distal to proximal to identify the point of obstruction, with careful handling of fragile and dilated bowel. Critical goals for surgery include identification and relief of the point of obstruction, resection of nonviable bowel, and avoidance of inadvertent enterotomy. Conversion to open surgery should be undertaken expeditiously when it is determined that one of these goals cannot be safely accomplished laparoscopically. Many studies, though retrospective and not randomized, suggest improved early morbidity with laparoscopic exploration, though with high rates of conversion to open surgery. Conflicting results exist on whether open or laparoscopic exploration carries a higher risk of iatrogenic enterotomy. Further studies are needed to assess how laparoscopic adhesiolysis will impact long-term recurrence SBO.


Laparoscopy Laparoscopic Bowel obstruction SBO Adhesions Adhesiolysis Minimally invasive surgery 


  1. 1.
    Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH. Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc. 1991;1(4):259–62.CrossRefGoogle Scholar
  2. 2.
    O’Connor DB, Winter DC. The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc. 2012;26(1):12–7.CrossRefGoogle Scholar
  3. 3.
    Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203(2):170–6.CrossRefGoogle Scholar
  4. 4.
    Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A. Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc. 2015;29(9):2525–32.CrossRefGoogle Scholar
  5. 5.
    Davies SW, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T, et al. A comparative analysis between laparoscopic and open adhesiolysis at a tertiary care center. Am Surg. 2014;80(3):261–9.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D. Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc. 2010;24(4):792–7.CrossRefGoogle Scholar
  7. 7.
    Behman R, Nathens AB, Byrne JP, Mason S, Look Hong N, Karanicolas PJ. 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. 2017;266(3):489–98.CrossRefGoogle Scholar
  8. 8.
    Wiggins T, Markar SR, Harris A. Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis. Surg Endosc. 2015;29(12):3432–42.CrossRefGoogle Scholar
  9. 9.
    Yao S, Tanaka E, Matsui Y, Ikeda A, Murakami T, Okumoto T, et al. Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity score-matched analysis. Surg Endosc. 2017;31(12):5348–55.CrossRefGoogle Scholar
  10. 10.
    Pei KY, Asuzu D, Davis KA. 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. 2017;31(5):2180–6.CrossRefGoogle Scholar
  11. 11.
    Patel R, Borad NP, Merchant AM. Comparison of outcomes following laparoscopic and open treatment of emergent small bowel obstruction: an 11-year analysis of ACS NSQIP. Surg Endosc. 2018;32(12):4900–11.CrossRefGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  1. 1.Division of Colon and Rectal SurgeryLahey Hospital and Medical CenterBurlingtonUSA

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