Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstructions

The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6-39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.     

Single-port laparoscopic cholecystectomy: initial experience

Background

As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single small incision have begun to gain traction. Several commercially available products have emerged recently. The TriPort^TM system and the SILS^TM Port are single-port devices that allow the surgeon to perform laparoscopic surgery through a 2- to 3-cm periumbilical incision. This study aimed to ascertain whether these devices allow safe and reliable access for laparoscopic cholecystectomy.

Methods

From March 2008 to June 2009, single-port laparoscopic cholecystectomy was attempted for 22 patients with an average age of 40 years (range, 23–73 years). The data collected prospectively after institutional review board approval included demographics, operative time, complications, and reasons for conversion to standard four-port laparoscopic surgery.

Results

The operation was completed successfully for 21 of the 22 patients (15 women and 7 men) using five different techniques. The mean body mass index (BMI) of the patients was 32.7 kg/cm² (range, 22.3–46.1 kg/cm²). Three of the patients had previously undergone laparoscopic Roux-en-Y gastric bypass. The mean operative time was 80.8 min (range, 51–156 min). One patient experienced a Richter’s hernia postoperatively, which required a reoperation and subsequent bowel resection. One patient required conversion to a standard four-port laparoscopic cholecystectomy because the articulating instrument could not reach the gallbladder from the umbilicus.

Conclusion

The results from the current series show single-port laparoscopic cholecystectomy to be a promising technique. A variety of patient demographics appear suited to this approach. The operative time in this series compares favorably with that for the standard four-port operation. The feasibility of single-port laparoscopic cholecystectomy is now established. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies. In addition, its superiority over standard laparoscopic cholecystectomy in terms of postoperative pain, cosmesis, and overall patient satisfaction requires further study. Refinements in instrumentation will enable wider use of this novel minimally invasive approach.     

三阶段微创治疗急性粘连性肠梗阻

目的:建立分阶段中西医结合与腹腔镜微创手术联合治疗急性粘连性肠梗阻的方案,并探讨此方案的治疗效果。方法:将1997年10月至2004年12月急性粘连性肠梗阻173例患者分为三个阶段进行中西医结合微创联合治疗。第1阶段:急性期中西医结合非手术治疗解除梗阻,未解除梗阻者行急症腹腔镜探查或剖腹手术。第2阶段:缓解期行腹腔镜肠粘连松解术,去除引起肠梗阻的病因。第3阶段:是疗效巩固期,用中药治疗以避免术后粘连性肠梗阻再发。结果:术后随访,三阶段联合治疗71例,复发4例(5.6%);单纯中西医结合非手术治疗39例,复发24例(61.5%);开腹行肠粘连松解术15例,复发5例(33.3%)。急症腹腔镜手术15例,中转开腹7例(46.7%),发生并发症6例(40%);择期腹腔镜手术77例,中转开腹6例(7.8%),发生并发症6例(7.8%)。结论:分阶段中西医结合微创联合治疗急性粘连性肠梗阻的效果明显优于单一治疗方式。     

Laparoscopic approach to postoperative adhesive obstruction

Background Some authors have assessed the feasibility of laparoscopy in the treatment of postoperative adhesive obstruction, but conclusions about its effectiveness are related to different selection criteria used for surgery. This paper reports on our experience in laparoscopic adhesiolysis and analyses the results on the basis of the selection criteria used.Methods From January 1993 to December 2001, 65 patients were submitted to laparoscopic adhesiolysis for small bowel obstruction according to specific selection criteria. Of the 65 patients, 40 were admitted for acute obstruction and 25 for chronic or recurrent transit disturbances. Correlation between historical and clinical data and the results of surgical treatment were statistically analyzed.Results The procedure was completed by laparoscopy in 52 patients (conversion rate: 20%). Mean postoperative stay was 4.4 days with a 12.3% morbidity and no mortality. Recurrence rate was 15.4%; a single correlation was found between recurrence and age.Conclusions Laparoscopic adhesiolysis in the treatment of small bowel obstructions seems to be effective; further studies are required to define selection criteria for surgery and confirm real advantages in terms of recurrences.     

Small Bowel Obstruction and Internal Hernias after Laparoscopic Roux-en-Y Gastric Bypass

Background: Small bowel obstruction (SBO) is a recognized complication of open bariatric surgery; however, the incidence after laparoscopic procedures is not clearly established. This paper reviews our experience with small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Methods: Between 1995 and 2001, 711 (246 antecolic, 465 retrocolic) patients underwent a laparoscopic proximal divided Roux-en-Y gastric bypass via the linear endostapler technique. 13 patients (1.8%) developed SBO requiring surgical intervention.There were 11 females and 2 males, ages 29-60 (mean 38), with mean weight 126 kg (range 105-188), and mean BMI 50 (range 41-59). 7 obstructive patients (55%) had undergone previous open abdominal surgery. Median time to obstruction was 21 days (range 5-1095). Mean follow-up of all patients is 43 months (range 3-79). Results: Etiology of obstruction was internal hernia - 6, adhesive bands - 5 (only 2 were related to prior open surgery), mesocolon window scarring - 1, and incarcerated ventral hernia - 1. The incidence of SBO was 4.5% (11/246) in the retrocolic group, and 0.43% (2/465) in the antecolic group, which was highly significant (P=.006). 1 adhesive patient required an open bowel resection for ischemia. There was 1 death. Conclusion: SBO occurred with an overall incidence of 1.8% in a large series of laparoscopic gastric bypass patients, and was associated with a high morbidity. A significant decrease in occurrence was found after adoption of antecolic placement of the Roux limb.     

腹腔镜在粪石性小肠梗阻中的应用

目的探讨腹腔镜手术治疗粪石性小肠梗阻的临床价值。方法2011年5月～2013年11月对17例粪石性小肠梗阻在腹腔镜下找到梗阻部位,明确粪石性肠梗阻诊断后,以无损伤肠钳将粪石轻柔捏挤,然后将碎块连同肠内容物推挤过回盲瓣,检查梗阻近端肠管无粪石后结束手术。结果16例腹腔镜手术获成功,1例因粪石大且坚硬,嵌顿在肠管无法推动,反复在同一部位挤压粪石导致水肿肠管浆膜破裂,中转开放手术。腹腔镜手术时间12～29rain,平均21rain。16例术后住院2—6d,平均4．2d。术后随访3～6个月,腹腔镜手术成功患者无腹腔脓肿、肠漏、粘连性肠梗阻、切口感染等并发症,腹部瘢痕不明显。结论腹腔镜诊治粪石性小肠梗阻安全、简单、有效。     

Management of adhesive bowel obstruction in children is changed by laparoscopy

Background: With new advances in diagnostic and therapeutic tools, the early management of adhesive bowel obstruction has become feasible. Methods: In a retrospective study, 20 children with adhesive bowel obstruction were investigated to assess the possible advantages of the laparoscopic approach. Results: Laparoscopy was performed in nine children. Six of them were managed laparoscopically. Recovery was uneventful. In two children, extensive adhesions warranted elective conversion. The single complication occurred in a child with obstruction of the colon due to perforation caused by a small instrument. Eleven children underwent primary laparotomy for adhesive obstruction. Five of them had a single band and might have benefited from a laparoscopic approach. Conclusions: Laparoscopic management of adhesive bowel obstruction in children is feasible and safe in experienced hands. Early management saves the child a great deal of discomfort and allows a quick recovery with early discharge.     

自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用(附167例报告)

目的探讨自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用。方法回顾分析了从2011年6月至2014年5月笔者进行单孔后腹腔镜单纯肾切除术57例、单孔后腹腔镜肾癌根治术35例、单孔后腹腔镜肾上腺切除术36例、单孔后腹腔镜肾囊肿去顶术39例,共167例患者的临床资料。均采用1个切口保护套和1个无粉外科手套组成一个单孔多通道操作装置,使用常规腹腔镜器械进行单孔后腹腔镜手术,术后手术伤口常规予皮内缝合。结果 167例患者均成功进行单孔后腹腔镜手术,无改行常规后腹腔镜手术或开放手术。单孔后腹腔镜单纯肾切除术手术时间(90.0±38.2)分钟,单孔后腹腔镜肾癌根治术手术时间(120.0±33.7)分钟,单孔后腹腔镜肾上腺切除术手术时间(45.0±16.3)分钟,单孔后腹腔镜肾囊肿去顶术手术时间(35.0±15.6)分钟。术中出血量20~200ml,术后无需要输血患者,无重大手术并发症。所有患者均对手术伤口愈合后残留的微小瘢痕感到满意。结论应用自制单孔多通道装置进行泌尿外科单孔后腹腔镜手术安全可行、费用低,减少手术创伤。联合伤口皮内缝合,达到了患者的美观要求,应用前景广阔,可作为有手术伤口美观要求的患者,特别是女性患者行相关手术的首选治疗方法。     

Laparoscopic diagnosis and treatment of acute small bowel obstruction resulting from a congenital band

Acute small bowel obstruction is a common problem, especially for those patients with previous abdominal surgery that can cause postoperative adhesions. Acute, non-postoperative small bowel obstruction is less common and has various etiologies. We report a case of acute small bowel obstruction without previous abdominal surgery. The patient underwent laparoscopic exploration, and a congenital band was found to cause direct compression of the ileum and entrapment of a segment of bowel loop. There was evidence of bowel strangulation. The color and peristalsis of the entrapped bowel loop recovered gradually after division of the band, and segmental bowel resection was avoided. He has remained asymptomatic since the procedure. We suggest early and aggressive surgical intervention for patients with acute, non-postoperative small bowel obstruction to avoid possible complications of bowel strangulation and gangrene. A laparoscopic approach may be a safe, feasible, and favorable option for correct diagnosis and appropriate treatment in this situation.     

Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity

BACKGROUND: Bowel obstruction is increasingly recognized as an important complication after gastric bypass. This study analyzed late bowel obstruction after open and laparoscopic gastric bypass surgery. STUDY DESIGN: The medical records of 1,378 patients who had proximal gastric bypass during the years 2002 and 2003 at a large bariatric center were evaluated for readmission with bowel obstruction requiring operations. In the study group, 697 patients underwent a laparoscopic approach and 735 had an open approach to gastric bypass. Patients had a minimum followup of 18 months. RESULTS: In the laparoscopic group, 68 of the 697 patients were readmitted for bowel obstruction requiring operations, for an incidence of 9.7%. There were 14 additional recurrent obstructions, for a total of 82 operations. Of the 68 patients requiring reoperations, 3 (4.4%) required bowel resection and 8 (11.7%) had conversion to an open approach. Bowel resections were performed in two of the three patients with a second episode of bowel obstruction. The average time intervals between the primary operation in 2002 and 2003 and the first episode of obstruction were 511 and 385 days, respectively. There were no readmissions requiring operations for late bowel obstruction in the open gastric bypass group. CONCLUSIONS: We found an unanticipated high incidence of bowel obstruction after laparoscopic gastric bypass surgery. There were no hospital admissions for bowel obstruction requiring operations in the open gastric bypass group. Lack of adhesions and the resulting free displacement of small bowel after laparoscopy appear to be the cause of this complication. Open gastric bypass surgery produces thin, diffuse upper abdominal adhesions that may then stabilize the bowel and prevent internal hernias and bowel obstruction. An open approach may be a reasonable option for management of recurrent episodes of bowel obstruction after laparoscopy.     

Laparoscopic approach to acute small bowel obstruction: Review of 1061 cases

Background Acute small bowel obstruction has previously been considered a relative contraindication for laparoscopic management. As experience with laparoscopy grows, more surgeons are attempting laparoscopic management for this indication. The purpose of this study is to define the outcome of laparoscopy for acute small bowel obstruction through an analysis of published cases. Methods A literature search of the Medline database was performed using the key words laparoscopy and bowel obstruction. Further articles were identified from the reference lists of retrieved literature. Only English language studies were reviewed. We excluded studies that included patients with chronic abdominal pain, chronic recurrent small bowel obstruction, or gastric or colonic obstruction, when the data specific to acute small bowel obstruction could not be extracted. Data was analyzed based on an intention to treat. Results Nineteen studies from between 1994 and 2005 were identified. Laparoscopy was attempted in 1061 patients with acute small bowel obstruction. The most common etiologies of obstruction included adhesions (83.2%), abdominal wall hernia (3.1%), malignancy (2.9%), internal hernia (1.9%), and bezoars (0.8%). Laparoscopic treatment was possible in 705 cases with a conversion rate to open surgery of 33.5%. Causes of conversion were dense adhesions (27.7%), the need for bowel resection (23.1%), unidentified etiology (13.0%), iatrogenic injury (10.2%), malignancy (7.4%), inadequate visualization (4.2%), hernia (3.2%), and other causes (11.1%). Morbidity was 15.5% (152/981) and mortality was 1.5% (16/1046). There were 45 reported recognized intraoperative enterotomies (6.5%), but less than half resulted in conversion. There were, however, nine missed perforations, including one trocar injury, often resulting in significant morbidity. Early recurrence (defined as recurrence within 30 days of surgery) occurred in 2.1% (22/1046). Conclusion Laparoscopy is an effective procedure for the treatment of acute small bowel obstruction with acceptable risk of morbidity and early recurrence.     

Laparoscopic diagnosis and treatment of small bowel obstruction caused by postoperative intussusception

Small bowel obstruction is a common problem, especially for patients who have had previous abdominal surgery possibly complicated by postoperative adhesions. In contrast to adhesions, postoperative intussusception is an unusual cause of small bowel obstruction. We report a case of small bowel obstruction that occurred one month after antrectomy for duodenal ulcer with massive bleeding. Laparoscopic surgery was attempted after conservative treatment failed. A segment of jejunojejunal intussusception about 50 cm below the ligament of Treitz was identified and laparoscopic reduction of the intussusception was performed. The patient had an uneventful postoperative course and remained asymptomatic at 10-month follow-up. Although not frequently encountered, postoperative intussusception should be considered a possible etiology in patients with postoperative small bowel obstruction. In experienced hands, the laparoscopic approach offers a feasible option for correct diagnosis and appropriate treatment in this situation.     

Laparoscopic surgery for the management of obstruction of the gastric outlet and small bowel following previous laparotomy for major upper gastrointestinal resection or cancer palliation: a new concept

BACKGROUND: Surgical relief of gastric outlet obstruction (GOO) or small bowel obstruction in patients who had undergone major resection or palliative bypass surgery for malignancy is conventionally achieved at a laparotomy. The potential role of minimally invasive surgery in the management of these complications has not been previously explored. METHODS: Between 2003 and 2004, 4 consecutive patients, age range 37 to 72 years, where admitted with gastric outlet or proximal small bowel obstruction following previous open surgery for suspected intra-abdominal malignancy, under the care of one surgeon. The respective past histories of these patients were recurrent GOO and concomitant distal biliary obstruction following a previous open gastric bypass elsewhere for metastatic pancreatic head cancer; persistent adhesive small bowel obstruction following radical gastrectomy for gastric cancer; GOO secondary to intra-abdominal recurrence 6 months after hepatobiliary resection for hilar cholangiocarcinoma; and GOO following previous pancreatico-duodenectomy for suspected pancreatic head cancer. Their respective surgical management consisted of a laparoscopic re-do gastric bypass and concomitant cholecystojejunostomy; adhesiolysis and revision of the Roux-en-Y enteric anastomosis; a Devine exclusion gastroenterostomy; and resection and refashioning of the gastroenterostomy. RESULTS: There were no conversions to open surgery and no postoperative complications. The median operating time was 240 minutes (range, 145 to 300 minutes). Oral free fluid intake was resumed on postoperative day (POD) 1, while diet was resumed between POD 2 and 4. The median postoperative hospital stay was 15.5 days (range, 14 to 25 days). CONCLUSION: Previous laparotomy and major resection or palliation of malignancy do not preclude the application of the laparoscopic approach for the management of upper gastrointestinal obstruction. Laparoscopic adhesiolysis and revision of enteroenteric and gastroenteric anastomoses are feasible management options in the hands of those experienced with complex laparoscopic surgery.     

Elective laparoscopy for small bowel obstruction

We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction.     

A Prospective Evaluation of Intracorporeal Laparoscopic Small Bowel Anastomosis during Gastric Bypass

Background: We evaluated the safety and feasibility of performing a laparoscopic intracorporeal end-toside small bowel anastomosis using a stapling technique as part of a Roux-en-Y gastric bypass operation (RYGBP). Methods: 80 consecutive patients who underwent RYGBP with laparoscopic jejunojejunostomy were evaluated. Operative time and intraoperative and postoperative complications directly related to the jejunojejunostomy anastomosis were recorded. Results: All 80 laparoscopic jejunojejunostomy procedures were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic RYGBP than for the last 40 RYGBP (32±18 min vs 21±14 min, respectively, p<0.05). Intraoperative complications were staple-line bleeding (2 patients) and narrowing of the anastomosis (1 patient). Postoperative complications were four small bowel obstructions: technical narrowing at jejunojejunostomy site (2 patients), angulation of the afferent limb (1 patient), and food impaction at the jejunojejunostomy anastomosis (1 patient). These four patients underwent successful laparoscopic re-exploration and creation of another jejunojejunostomy proximal to the original anastomosis. There were no small bowel anastomotic leaks. The median time to resuming oral diet was 2 days. Conclusions: Laparoscopic jejunojejunostomy as part of the RYGBP operation is a safe and technically feasible procedure. Postoperative small bowel obstruction is a potential complication, which can be prevented by avoiding technical narrowing of the afferent limb.     

经脐单孔腹腔镜肾盂离断成形术临床分析

目的 探讨经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄的手术技巧与临床应用价值.方法 2009年8月至2010年3月对15例肾盂输尿管连接部狭窄患者行经脐单孔腹腔镜肾盂离断成形术.男12例,女3例;平均年龄20(12～55)岁.均采用利尿性肾图、IVU、磁共振尿路造形术(MRU)等检查确诊,其中左侧9例,右侧6例.依病变部位在脐患侧缘行长约3.5 cm的切口建立单孔操作通道.采用Olympus四方向可弯曲腹腔镜,主要采用标准腹腔镜器械.肾盂离断成形方法基本同普通腹腔镜方法.结果 手术均成功,无中转开放手术者.平均手术时间为90(75～145)min.术中未出现器官损伤,术后未出现尿漏.患者平均住院时间6(4～8)d.术后随访4～6个月,患者腰痛症状消失,IVU和(或)B超检查肾积水明显减轻或消失,无吻合口再狭窄.结论 经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄安全、有效.

Abstract：

Objective To evaluate the surgical techniques and clinical applications of single-port transumlilical laparoscopic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Methods From August 2009 to March 2010, 15 patients were treated with single-port transumbilical laparoscopic dismembered pyeloplasty. There were 12 males and 3 females,aged 12 to 55 years with an average age of 20 years, who were diagnosed by diuretic renography,IVU, and MRU et al. A single umbilical incision of 3. 5cm was made for single-port trocar and a flexible-tip 0°digital video-laparoscope was used in all cases. The procedures were performed according to the methods used in classical laparoscopic dismembered pyeloplasty with general instruments. ResultsAll operations were performed successfully without conversion to open surgery. The mean operative time was 90 (75-145) min, and the mean hospital stay length was 6 days. No organs injury occurred during operation, and no urine leakage was found afer operation. The symptoms of low back pain disappeared and hydronephrosis reduced apparently or dispeared without any anastomotic stenosis after follow-up of 4-6 months. Conclusions Single-port transumbilical laparoscopic dismembered pyeloplasty is feasible, effective and safe for the treatment of UPJO.     

Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial

OBJECTIVE: To assess the therapeutic value of Gastrografin in the management of adhesive small bowel obstruction after unsuccessful conservative treatment. SUMMARY BACKGROUND DATA: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction. METHODS: Patients with clinical evidence of adhesive small bowel obstruction were given trial conservative treatment unless there was suspicion of strangulation. Those who responded in the initial 48 hours had conservative treatment continued. Patients showing no clinical and radiologic improvement in the initial 48 hours were randomized to undergo either Gastrografin meal and follow-through study or surgery. Contrast that appeared in the large bowel within 24 hours was regarded as a partial obstruction, and conservative treatment was continued. Patients in whom contrast failed to reach the large bowel within 24 hours were considered to have complete obstruction, and laparotomy was performed. For patients who had conservative treatment for more than 48 hours with or without Gastrografin, surgery was performed when there was no continuing improvement. RESULTS: One hundred twenty-four patients with a total of 139 episodes of adhesive obstruction were included. Three patients underwent surgery soon after admission for suspected bowel strangulation. Strangulating obstruction was confirmed in two patients. One hundred one obstructive episodes showed improvement in the initial 48 hours and conservative treatment was continued. Only one patient required surgical treatment subsequently after conservative treatment for 6 days. Thirty-five patients showed no improvement within 48 hours. Nineteen patients were randomized to undergo Gastrografin meal and follow-through study and 16 patients to surgery. Gastrografin study revealed partial obstruction in 14 patients. Obstruction resolved subsequently in all of them after a mean of 41 hours. The other five patients underwent laparotomy because the contrast study showed complete obstruction. The use of Gastrografin significantly reduced the need for surgery by 74%. There was no complication that could be attributed to the use of Gastrografin. No strangulation of bowel occurred in either group. CONCLUSIONS: The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the need for surgery when conservative treatment fails.     

Laparoscopic repair of an internal supravesical hernia: a rare hernia causing small bowel obstruction

The application of diagnostic laparoscopy in emergency surgery has facilitated a wide range of endoscopic operative procedures. We report an extremely rare case of a patient who had a bowel obstruction caused by an internal supravesical hernia that was repaired via a minimally invasive technique. Abdominal computed tomography (CT) showed signs of small bowel obstruction: the cause was thought to be an invagination due to a small bowel tumor. Laparoscopic exploration of the dilated small bowel segments allowed the diagnosis of supravesical hernia. Reduction was performed with slight traction, and the hernial orifice was closed with intracorporeal sutures. To our knowledge, this is the first repair of an internal supravesical hernia ever to receive herniorraphy based on laparoscopic techniques. The mean starting time for bowel-function and mean hospital stay following the laparoscopic release of the intestinal obstruction were significantly shorter than is typically seen with standard techniques.     

Laparoscopic management of mechanical small bowel obstruction

Background: Laparoscopy is used increasingly for the management of acute abdominal conditions. For many years, previous abdominal surgery and intestinal obstruction have been regarded as contraindications to laparoscopy because there is an increased risk of iatrogenic bowel perforation. The role of laparoscopy in acute small bowel obstruction remains unclear. Methods: Since 1995, data from patients undergoing laparoscopic surgery have been entered prospectively into a database. Patients who underwent surgery before 1995 were added retrospectively to the same database. The charts of all patients treated surgically for mechanical small bowel obstruction were reviewed. Univariate analysis was performed to identify factors associated with success or failure, especially intraoperative complications, conversion, and postoperative morbidity. Stepwise logistic regression was used to assess for independent variables. Results: This study included 83 patients (56 women and 27 men) with a mean age of 56 years (range, 17–91 years). Conversion was necessary in 36 cases (43%). Laparoscopy alone was successful in 47 patients (57%). Intraoperative complications were noted in 16% and postoperative complications in 31% of the patients. Eight reoperations (9%) were necessary. Mortality was 2.4%. Duration of surgery (p < 0.001) and a bowel diameter exceeding 4 cm (p= 0.02) were predictors of conversion. No risk factor for intraoperative complication was identified. Accidental bowel perforation (p= 0.008) and the need for conversion (p= 0.009) were the only independent factors associated with an increased risk of postoperative complications. Conclusions: Laparoscopic management of small bowel obstruction is possible in roughly 60% of the patients selected for this approach. Morbidity is lower, resumption of a normal diet is faster, and hospital stay is shorter than with patients requiring conversion. No clear predictor of success or failure was identified, but intraoperative complications must be avoided. If the surgeon is widely experienced in advanced laparoscopic surgery and there is a liberal conversion policy, laparoscopy is a valuable alternative to conventional surgery in the management of acute small bowel obstruction. Received: 20 July 1999/Accepted: 22 November 1999/Online publication: 17 April 2000     

Laparoscopic surgery for small bowel obstruction

At the beginning of the laparoscopic surgery, intestinal obstruction was considered an absolute contraindication for this approach, because of the high risk of injuring the bowel. Today, the increased experience allows to apply this method in certain selected cases of small intestine obstruction. We realised a retrospective study, over a period of 7 and a half years (January 1997 - June 2004), regarding the patients admitted and treated in our department for small intestine obstruction, both by open surgery (88 cases) and by laparoscopic surgery (11 cases). We compared the preoperative characteristics of the two subgroups, highlighting the importance of a careful selection of the cases for the success of the laparoscopic approach. We analysed the postoperative evolution of these patients (return of bowel function, postoperative wound evolution, hospital stay, socioeconomic reintegration), which allowed us to draw the conclusion that some of the patients with obstruction of the small intestine may benefit from the advantages of the mini-invasive surgery.