Laparoscopic Management of Small Bowel Obstruction

  • John HagenEmail author


Small bowel obstructions from any etiology can be managed laparoscopically. There been some controversy as to the safety of laparoscopy because of the concern that dilated small bowel could be injured either with insertion of the first port or with laparoscopic manipulation [1, 8]. The initial management will depend upon the suspected etiology of the small bowel obstruction. The usual surgical principles should be applied of nasogastric suction, intravenous fluids, and stabilization of the patient. Consideration should be made to the insertion of the first port to avoid injury to the dilated loops of the small intestine. This chapter will deal with the safe management of small bowel obstruction laparoscopically (Video 10.1).


Safe port placement Adhesiolysis Hernias Food bolus Tumors Gallstone ileus 

Supplementary material

Video 10.1

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  1. 1.
    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. doi: Epub 2011 Sep 5.CrossRefPubMedGoogle Scholar
  2. 2.
    Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc. 2007;21(11):1945–1949. Epub 2007 Sep 19.CrossRefPubMedGoogle Scholar
  3. 3.
    Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK. A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg. 2016;212(1):138–50. doi:10.1016/j.amjsurg.2016.01.030. Epub 2016 Apr 13.CrossRefPubMedGoogle Scholar
  4. 4.
    Elnahas A, Kim SH, Okrainec A, Quereshy F, Jackson TD. Is laparoscopic repair of incarcerated abdominal hernias safe? Analysis of short-term outcomes. Surg Endosc. 2016;30(8):3262–6. doi:10.1007/s00464-015-4649-0. Epub 2015 Nov 5.CrossRefPubMedGoogle Scholar
  5. 5.
    Zygomalas A, Karamanakos S, Kehagias I. Totally laparoscopic management of gallstone ileus – technical report and review of the literature. J Laparoendosc Adv Surg Tech A. 2012;22(3):265–8. doi:10.1089/lap.2011.0375. Epub 2012 Feb 3.CrossRefPubMedGoogle Scholar
  6. 6.
    Quinn M, Luke D. Oesophageal stent migration following Billroth I gastrectomy: an unusual cause of small bowel obstruction. J Surg Case Rep. 2013;2013(2):pii: rjt004. doi:10.1093/jscr/rjt004.CrossRefGoogle Scholar
  7. 7.
    Ferguson HJ, Ferguson CI, Speakman J, Ismail T. Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond). 2015;4(3):264–70. doi:10.1016/j.amsu.2015.07.018. eCollection 2015.CrossRefGoogle Scholar
  8. 8.
    Nordin A, Freedman J. Laparoscopic versus open surgical management of small bowel obstruction: an analysis of clinical outcomes. Surg Endosc. 2016. [Epub ahead of print].Google Scholar
  9. 9.
    Qureshi I, Awad ZT. Predictors of failure of the laparoscopic approach for the management of small bowel obstruction. Am Surg. 2010;76(9):947–50.PubMedGoogle Scholar
  10. 10.
    Goussous N, Kemp KM, Bannon MP, Kendrick ML, Srvantstyan B, Khasawneh MA, Zielinski MD. Early postoperative small bowel obstruction: open vs laparoscopic. Am J Surg. 2015;209(2):385–90. doi:10.1016/j.amjsurg.2014.07.012. Epub 2014 Oct 13.CrossRefPubMedGoogle Scholar
  11. 11.
    Geubbels N, Röell EA, Acherman YI, Bruin SC, van de Laar AW, de Brauw LM. Internal herniation after laparoscopic Roux-en-Y gastric bypass surgery: pitfalls in diagnosing and the introduction of the AMSTERDAM classification. Obes Surg. 2016;26(8):1859–66. doi:10.1007/s11695-015-2028-5.CrossRefPubMedGoogle Scholar
  12. 12.
    Parsi S, Rivera C, Vargas J, Silberstein MW. Laparoscopic-assisted extirpation of a phytobezoar causing small bowel obstruction after Roux-en-Y laparoscopic gastric bypass. Am Surg. 2013;79(2):E93–5.PubMedGoogle Scholar
  13. 13.
    Nilsson H, Nilsson E, Angerås U, Nordin P. Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia. 2011;15(3):301–7. doi:10.1007/s10029-011-0782-4. Epub 2011 Jan 26.CrossRefPubMedGoogle Scholar
  14. 14.
    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. 2016. [Epub ahead of print].Google Scholar
  15. 15.
    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. doi:10.1007/s00464-014-4015-7. Epub 2014 Dec 6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Toronto Humber River HospitalTorontoCanada

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