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Erschienen in: Surgical Endoscopy 10/2016

29.02.2016

Laparoscopic versus open surgical management of small bowel obstruction: an analysis of clinical outcomes

verfasst von: Ann Nordin, Jacob Freedman

Erschienen in: Surgical Endoscopy | Ausgabe 10/2016

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Abstract

Background

Laparotomy is the standard surgical approach for treatment of small bowel obstruction (SBO). Laparoscopic management could be beneficial in terms of less complications and shorter hospital stay. As the minimal invasive approach is gaining more acceptances in the treatment of SBO, there is an increased need of studies to analyze outcomes. The aim of the present study was to compare the short-term clinical outcomes of laparoscopy versus laparotomy in the surgical management of non-bariatric, non-malignant SBO.

Methods

A retrospective analysis of patients treated for SBO during 2010–2015 was made by a comprehensive search of medical records. A matched-pair review was performed on patients managed surgically for non-bariatric, non-malignant SBO at Danderyd University Hospital, Stockholm, Sweden. Completed laparoscopic surgeries were matched against patients treated with open surgery.

Results

Laparoscopy for SBO was initiated in 71 patients. Conversion to open surgery was performed in 42 %. Results from the matched-pair analysis showed that post-operative length of stay was reduced by 60 % (P < 0.001) in the laparoscopic cohort. Additionally, less major complications were reported and duration of surgery was reduced by 50 % (P < 0.001).

Conclusions

Laparoscopic management is a safe and feasible alternative to laparotomy. Hospital length of stay was significantly shorter and morbidity rate acceptable.
Literatur
1.
Zurück zum Zitat Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 21:1945–1949CrossRefPubMed Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 21:1945–1949CrossRefPubMed
2.
Zurück zum Zitat 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 28:2381–2386CrossRefPubMed 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 28:2381–2386CrossRefPubMed
3.
Zurück zum Zitat Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ (2012) Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, United States, pp S362–S369 Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ (2012) Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, United States, pp S362–S369
4.
Zurück zum Zitat Sikirica V, Bapat B, Candrilli SD, Davis KL, Wilson M, Johns A (2011) The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg 11:13CrossRefPubMedPubMedCentral Sikirica V, Bapat B, Candrilli SD, Davis KL, Wilson M, Johns A (2011) The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg 11:13CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat 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 76:696–703CrossRefPubMed 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 76:696–703CrossRefPubMed
6.
Zurück zum Zitat 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 28:65–73CrossRefPubMed 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 28:65–73CrossRefPubMed
7.
Zurück zum Zitat Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M (2012) Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis 14:e208–e215CrossRefPubMed Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M (2012) Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis 14:e208–e215CrossRefPubMed
8.
Zurück zum Zitat Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandala V, Mandala S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F (2013) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 8(1):42 Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandala V, Mandala S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F (2013) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 8(1):42
9.
Zurück zum Zitat Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540CrossRefPubMed Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540CrossRefPubMed
10.
Zurück zum Zitat Barmparas G, Branco BC, Schnuriger B, Lam L, Inaba K, Demetriades D (2010) The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 14:1619–1628CrossRefPubMed Barmparas G, Branco BC, Schnuriger B, Lam L, Inaba K, Demetriades D (2010) The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 14:1619–1628CrossRefPubMed
11.
Zurück zum Zitat Lupei MI, Chipman JG, Beilman GJ, Oancea SC, Konia MR (2014) The association between ASA status and other risk stratification models on postoperative intensive care unit outcomes. Anesth Analg 118(5):989–994CrossRefPubMed Lupei MI, Chipman JG, Beilman GJ, Oancea SC, Konia MR (2014) The association between ASA status and other risk stratification models on postoperative intensive care unit outcomes. Anesth Analg 118(5):989–994CrossRefPubMed
12.
Zurück zum Zitat Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH 3rd (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1:259–262CrossRefPubMed Bastug DF, Trammell SW, Boland JP, Mantz EP, Tiley EH 3rd (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1:259–262CrossRefPubMed
13.
Zurück zum Zitat Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D (2009) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24(4):792–797CrossRef Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D (2009) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24(4):792–797CrossRef
14.
Zurück zum Zitat 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(4):520–526CrossRefPubMed 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(4):520–526CrossRefPubMed
15.
Zurück zum Zitat Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A (2014) Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 29(9):2525–2532CrossRefPubMed Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A (2014) Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 29(9):2525–2532CrossRefPubMed
16.
Zurück zum Zitat O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2000 cases. Surg Endosc 26:12–17CrossRefPubMed O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2000 cases. Surg Endosc 26:12–17CrossRefPubMed
17.
Zurück zum Zitat Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151CrossRefPubMed Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151CrossRefPubMed
18.
Zurück zum Zitat 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 21:742–746CrossRefPubMed 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 21:742–746CrossRefPubMed
19.
Zurück zum Zitat Farinella E, Cirocchi R, La Mura F, Morelli U, Cattorini L, Delmonaco P, Migliaccio C, De Sol AA, Cozzaglio L, Sciannameo F (2009) Feasibility of laparoscopy for small bowel obstruction. World J Emerg Surg 4:3CrossRefPubMedPubMedCentral Farinella E, Cirocchi R, La Mura F, Morelli U, Cattorini L, Delmonaco P, Migliaccio C, De Sol AA, Cozzaglio L, Sciannameo F (2009) Feasibility of laparoscopy for small bowel obstruction. World J Emerg Surg 4:3CrossRefPubMedPubMedCentral
Metadaten
Titel
Laparoscopic versus open surgical management of small bowel obstruction: an analysis of clinical outcomes
verfasst von
Ann Nordin
Jacob Freedman
Publikationsdatum
29.02.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 10/2016
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-4776-2

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