The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction

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  • dc.contributor.author Sebastian-Valverde, Enric
  • dc.contributor.author Poves Prim, José Ignacio
  • dc.contributor.author Membrilla Fernández, Estela
  • dc.contributor.author Pons Fragero, María José
  • dc.contributor.author Grande Posa, Luís
  • dc.date.accessioned 2019-11-15T09:25:58Z
  • dc.date.available 2019-11-15T09:25:58Z
  • dc.date.issued 2019
  • dc.description.abstract BACKGROUND: Postoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity. METHODS: A retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO. RESULTS: 262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38.5%. Patients in the laparoscopic group were younger (p < 0.001), had fewer previous abdominal operations (p = 0.001), lower ASA grade (p < 0.001), and less complex adhesions were found (p = 0.001). Operative time was longer in the open group (p = 0.004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67.9%, p < 0.001), lower mortality (p = 0.026), earlier oral intake (p < 0.001) and shorter hospital stay (p < 0.001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2.89; 95% CI 1.1-7.6; p = 0.033). CONCLUSIONS: Laparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Sebastian-Valverde E, Poves I, Membrilla-Fernández E, Pons-Fragero MJ, Grande L. The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction. BMC Surg. 2019 Apr 24;19(1):40. DOI 10.1186/s12893-019-0504-x
  • dc.identifier.doi http://dx.doi.org/10.1186/s12893-019-0504-x
  • dc.identifier.issn 1471-2482
  • dc.identifier.uri http://hdl.handle.net/10230/42864
  • dc.language.iso eng
  • dc.publisher BioMed Central
  • dc.rights Copyright © The Author(s). 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword Intestinal obstruction
  • dc.subject.keyword Laparoscopy
  • dc.subject.keyword Length of stay
  • dc.subject.keyword Small intestine
  • dc.subject.keyword Tissue adhesions
  • dc.title The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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