Laparoscopy for Small Bowel Obstruction Caused by Single Adhesive Band

Abstract

Background and Objectives:There are still concerns about the comparative outcomes of operative treatment (OT) and conservative (nonsurgical) treatment (CT) for small bowel obstruction (SBO), especially that caused by single adhesive bands. We performed a retrospective study to compare surgical with nonsurgical outcomes.Methods:A total of 62 patients were enrolled. The OT group underwent laparoscopy (n = 16), and the CT group (n = 46) did not. We compared early and late outcomes between the 2 groups.Results:Times to first flatus, oral intake, and defecation after treatment were shorter in the OT group (P = .030, .033, and .024), and the recurrence rate was lower in the OT group than in the CT group (6.2% vs 32.6%; P = .038). Time from discharge to first recurrence was longer in the OT group than in the CT group (172 vs 104.6 ± 26.5 days, P = .027).Conclusions:SBO related to a single adhesive band is not effectively treated by CT. However, laparoscopic OT provides notable success if the surgery is performed early. Therefore, it should be the preferred treatment.

Laparoscopy in small bowel obstruction - current status - review.

“…Acute SBO is an urgent medical condition observed in almost 16% of all acute surgical cases (USA), and it requires urgent medical decisions on how to proceed. So far, the literature includes discussions over superiority of surgical methods over conservative treatment and discussions over the opposite approach [ 7 , 8 ].…”

“…This latter examination is especially important with regard to precise detection of causes of obstruction, especially other than postoperative adhesions or strangulation, and at the same time its sensitivity and specificity reach 90% [ 5 , 9 ]. Computed tomography is also important when planning a delay of a surgical intervention [ 7 ]. A routine ultrasound examination that is often underestimated due to technical issues caused by excessive intestinal gases may be diagnostically helpful especially in cases where intestinal ischaemia is also observed [ 5 ].…”

“…Based on studies, some predictive parameters that may help make a decision to qualify patients for surgical treatment have also been determined. They include older age, presence of ascites, significant retention of gastric contents decompressed by a nasogastric tube or mesenteric swelling visible on CT [ 7 , 11 ]. One should remember that in all cases surgical treatment alone is associated with statistically better long-term results and a statistically lower rate of recurrence of adhesions compared to conservative treatment; in the latter case as many as 31–40% of patients will have another obstruction that will require surgical treatment the most frequently [ 5 , 7 , 12 ].…”

Specific Features of Laparoscopic Adhesiolysis in Adhesive Small Intestinal Obstruction

“…Основными причинами лапаротомной конверсии являются трудная экспозиция и сложности с пересечением спаечных тяжей. Это связано с сокращением операционного поля, вызванного дилатацией тонкой кишки, множественными спаечными образованиями, а иногда и наличием спаек на задней поверхности париетальной брюшины, которые труднее обрабатывать лапароскопически [2,12,13].…”

Ileus tube placement combined with laparoscopy in the treatment of refractory small bowel obstruction: Case series and literature review

“…[1][2][3] And SBO is the most common causes of acute hospital admission. 4 Furthermore, admission for adhesion-related SBO is associated with a mortality rate as high as 10%. 5 Most SBOs (67.2%) can be managed with conservative treatment.…”