Laparoscopy in acute care surgery continues to expand. While adhesive small bowel obstruction (SBO) has traditionally been managed via an open approach, appropriately selected patients may benefit from laparoscopy. The objective of our study was to compare short-term postoperative outcomes in patients with adhesive SBO treated with laparotomy versus laparoscopy.
Using the ACS NSQIP participant use files (2005–10), patients with a postoperative diagnosis of adhesive SBO were selected for inclusion in this study. Patients with bowel resections or concomitant procedures were excluded. Both univariate analyses and multivariate logistic regression were performed to compare 30-day outcomes in the open and laparoscopic groups.
A total of 4,616 patients with adhesive SBO were identified: 3,697 (80.1 %) and 919 (19.3 %) in the open and laparoscopic groups, respectively. Mean operative time was similar in both groups. The mortality and overall complications were 84 (2.3 %) and 819 (22.2 %), respectively, in the open group compared to 7 (0.8 %) and 81 (8.8 %) in the laparoscopic group, with respective unadjusted odds ratios (ORs) of 0.33 (0.13–0.71, P < 0.01) and 0.39 (0.30–0.49, P < 0.01). The adjusted OR for overall complications was 0.46 (0.37–0.59, P < 0.01) favouring the laparoscopic group. The mean postoperative length of stay (LOS) was 8.4 days compared to 3.8 in the open and laparoscopic groups, respectively (P < 0.01).
The laparoscopic approach to treating adhesive SBO resulted in significantly fewer complications and shorter LOS.
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American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. No external sources of funding were used for this study.
Dr. Allan Okrainec is a consultant for Covidien and receives honoraria for speaking and teaching. Drs. Fady Saleh, Luciano Ambrosini, and Timothy Jackson have no conflicts of interest or financial ties to disclose.
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Saleh, F., Ambrosini, L., Jackson, T. et al. Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes. Surg Endosc 28, 2381–2386 (2014). https://doi.org/10.1007/s00464-014-3486-x
- Small bowel obstruction