Abstract
Background
The outcomes of laparoscopic adhesiolysis for small bowel obstruction have generally been satisfactory over the short term. However, the long-term outcomes, including recurrence of symptoms and management of recurrence, remain controversial. This study compares the long-term outcomes of a series of laparoscopic and open surgery procedures for the treatment of small bowel obstruction.
Methods
Patients who underwent adhesiolysis for small bowel obstruction at our institution between 2008 and 2015 were retrospectively reviewed. In total, 156 patients were enrolled, 78 with laparoscopic and 78 with open surgery. Propensity score matching was used to minimize the bias in patient selection. Long-term outcomes included incidence of recurrent symptoms and reoperation. In addition to the comparison of outcomes, risk factor assessment for recurrent symptoms and analysis of detailed information in patients with reoperation were performed. Statistical methods included χ 2 test, Mann–Whitney U test, Cox proportional hazards model, and Kaplan–Meier plots with log-rank comparison.
Results
Laparoscopy was performed in a younger population with milder bowel dilation and less complicated etiologies. These factors were used to construct the propensity score model, which yielded a matched cohort of 52 legs in each group. Laparoscopy achieved good short-term outcomes including early recovery of gastrointestinal function, reduced incidence of complications, and shorter hospital stay. For long-term outcomes, while the overall recurrence rate did not differ between the groups (11.5 vs 7.7%), the incidence of reoperation for recurrence was significantly higher in the laparoscopically treated group (7.7 vs 0%, p = .017). The Cox proportional hazards model showed that multiple prior surgeries (≥3 times) were a risk factor for overall recurrence (hazard ratio 7.39, p = .041).
Conclusion
Laparoscopic adhesiolysis did not decrease the incidence of recurrent symptoms; rather, it was related to higher incidence of recurrent small bowel obstruction requiring surgical treatment.
Similar content being viewed by others
References
Saleh F, Ambrosini L, Jackson T, Okrainec A (2014) Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes. Surg Endosc 28:2381–2386. doi:10.1007/s00464-014-3486-x
Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A (2015) Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 29:2525–2532. doi:10.1007/s00464-014-4015-7
Li MZ, Lian L, Xiao LB, Wu WH, He YL, Song XM (2012) Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 204:779–786. doi:10.1016/j.amjsurg.2012.03.005
Lombardo S, Baum K, Filho JD, Nirula R (2014) Should adhesive small bowel obstruction be managed laparoscopically? A National Surgical Quality Improvement Program propensity score analysis. J Trauma Acute Care Surg 76:696–703. doi:10.1097/TA.0000000000000156
Wiggins T, Markar SR, Harris A (2015) Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis. Surg Endosc 29:3432–3442. doi:10.1007/s00464-015-4114-0
Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK (2016) A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg 212:138–150. doi:10.1016/j.amjsurg.2016.01.030
Nordin A, Freedman J (2016) Laparoscopic versus open surgical management of small bowel obstruction: an analysis of clinical outcomes. Surg Endosc 30:4454–4463. doi:10.1007/s00464-016-4776-2
Sato Y, Ido K, Kumagai M, Isoda N, Hozumi M, Nagamine N, Ono K, Shibusawa H, Togashi K, Sugano K (2001) Laparoscopic adhesiolysis for recurrent small bowel obstruction: long-term follow-up. Gastrointest Endosc 54:476–479
Borzellino G, Tasselli S, Zerman G, Pedrazzani C, Manzoni G (2004) Laparoscopic approach to postoperative adhesive obstruction. Surg Endosc 18:686–690. doi:10.1007/s00464-003-9106-9
Mathieu X, Thill V, Simoens C, Smets D, Ngongang C, Debergh N, da Costa PM (2008) Laparoscopic management of acute small bowel obstruction: a retrospective study on 156 patients. Hepatogastroenterology 55:522–526
Wang Q, Hu ZQ, Wang WJ, Zhang J, Wang Y, Ruan CP (2009) Laparoscopic management of recurrent adhesive small-bowel obstruction: long-term follow-up. Surg Today 39:493–499. doi:10.1007/s00595-008-3906-4
Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151. doi:10.1002/bjs.4177
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 244:750–757. doi:10.1097/01.sla.0000225097.60142.68
Fevang BT, Fevang J, Lie SA, Soreide O, Svanes K, Viste A (2004) Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 240:193–201
O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc 26:12–17. doi:10.1007/s00464-011-1885-9
Levard H, Boudet MJ, Msika S, Molkhou JM, Hay JM, Laborde Y, Gillet M, Fingerhut A, R French Association for Surgical (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71:641–646
Grafen FC, Neuhaus V, Schob O, Turina M (2010) Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 395:57–63. doi:10.1007/s00423-009-0490-z
Lujan HJ, Oren A, Plasencia G, Canelon G, Gomez E, Hernandez-Cano A, Jacobs M (2006) Laparoscopic management as the initial treatment of acute small bowel obstruction. JSLS 10:466–472
Mancini GJ, Petroski GF, Lin WC, Sporn E, Miedema BW, Thaler K (2008) Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg 207:520–526. doi:10.1016/j.jamcollsurg.2008.04.026
Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, Nogueras JJ, Vernava AM 3rd, Wexner SD (2007) Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc 21:742–746. doi:10.1007/s00464-007-9212-1
Sallinen V, Wikstrom H, Victorzon M, Salminen P, Koivukangas V, Haukijarvi E, Enholm B, Leppaniemi A, Mentula P (2014) Laparoscopic versus open adhesiolysis for small bowel obstruction—a multicenter, prospective, randomized, controlled trial. BMC Surg 14:77. doi:10.1186/1471-2482-14-77
Kelly KN, Iannuzzi JC, Rickles AS, Garimella V, Monson JR, Fleming FJ (2014) Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc 28:65–73. doi:10.1007/s00464-013-3162-6
Davies SW, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T, Sawyer RG, Hallowell PT (2014) A comparative analysis between laparoscopic and open adhesiolysis at a tertiary care center. Am Surg 80:261–269
Acknowledgements
The authors are grateful to Dr. Yosuke Kasai (Kyoto University) for offering advice on study design and to Edanz Ltd. for giving their medical editing services.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Eiji Tanaka, Yugo Matsui, Atsushi Ikeda, Teppei Murakami, Tatsuo Okumoto, Takehisa Harada, and Siyuan Yao have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Yao, S., Tanaka, E., Matsui, Y. et al. Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity score-matched analysis. Surg Endosc 31, 5348–5355 (2017). https://doi.org/10.1007/s00464-017-5615-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5615-9