Enteroclysis-Guided Laparoscopic Adhesiolysis in Recurrent Adhesive Small Bowel Obstructions

Abstract

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.

Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital

“…In addition, short-term outcome until discharge clearly demonstrates the superiority of a successful laparoscopic management in terms of decreased operative time, length of hospital and ICU stay, and reduced overall mortality. Our conversion rate of 30% compares favorably to existing reports in which conversion rates range from 6.7% to 43% [20,[22][23][24]. The comparably low conversion rate of 17% by Mancini et al in their study of 6,165 patients with adhesion-related SBO may be explained by the low initial percentage (11%) of patients treated laparoscopically, indicating a positive selection of patients amenable to successful laparoscopic adhesiolysis [5].…”

Comparative Histomorphological Study of Intestinal Anastomosis by Laparoscopic vs Conventional Methods in Dogs.

“…These histopathological changes were represented by villous atrophy and/or delayed and partial regeneration of the intestinal mucosa at the site of anastomosis associated with intensive fibrous connective tissue proliferation and marked inflammatory cell infiltration in the submucosal layer. This finding could be attributed to the extensive trauma that associates the large surgical incision through the abdomen and the higher possibility of contamination and intra-abdominal infection due to exposure of abdominal organs to the atmosphere (5). It is in agreement with findings of other authors (7 , 8 , 13) who mentioned that intestinal anastomosis performed by laporoscopic surgery revealed shorter hospital stay and improved cosmetic results compared to intestinal anastomosis achieved by conventional laparotomy.…”

“…Today, intestinal anastomosis can be constructed intracorporeally or extracorporeally in a laparoscopic-assisted manner (4). Laparoscopy offers an advantage in that there is less exposure of peritoneal organs to the atmosphere, thus reducing the consequent potential for intra abdominal infection; it prevents drying of the peritoneal surfaces which may be responsible for tissue ischemia (5).…”

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

“…Other factors such as an elevated white blood cell count or a fever have not been demonstrated to correlate with an increased conversion rate [Suter et al, Navez et al]. One group of patients who are good candidates for laparoscopic adhesiolysis are those with a nonresolving, partial small bowel obstruction or a recurrent, chronic small bowel obstruction demonstrated on contrast study [ 108 , 109 ].…”