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Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes

Abstract

Background

Laparoscopic management of adhesive small bowel obstruction (SBO) has become an established technique within the domain of acute care surgery. As minimally invasive management of SBO becomes more widely accepted, there is increased need for reporting of outcomes.

Objective

To compare outcomes of laparoscopic versus open surgery for adhesive SBO.

Methods

Patients undergoing surgery for adhesive SBO at our institution between 2005 and 2013 were eligible for inclusion. The primary outcome was overall complication rate, while secondary outcomes included operative time, gastrointestinal (GI) function, and postoperative length of stay (LOS). Univariable analysis compared laparoscopic (including conversions) and open groups with regard to patient baseline and perioperative characteristics as well as outcomes of interest. Multivariable analysis was performed comparing the endpoint of overall complications between groups. Sensitivity analysis excluding patients who underwent bowel resection was performed to assess effect on outcomes. Factors associated with laparoscopic success, as well as impact of conversion to open on postoperative outcomes, are reported.

Results

A cohort of 269 patients with adhesive SBO was identified: 186 patients (69.1 %) underwent open surgery, 83 (30.9 %) were managed laparoscopically. Within the laparoscopy group, 32 (38.6 %) underwent conversion to open. Operative time was similar between groups (P = 0.506), while laparoscopy was associated with quicker recovery of GI function indicated by removal of nasogastric tube (P = 0.031) and passage of flatus (P = 0.005). Postoperative LOS was shorter (5 vs. 7 days, P = 0.031) with laparoscopy. The overall complication rate was significantly lower in the laparoscopic group (27.7 vs. 43.6 %, P = 0.014), with an adjusted odds ratio (OR) for overall complications of 0.37 (P = 0.002). Following exclusion of bowel resections, secondary outcomes continued to favor laparoscopy, while reduction in overall complications trended toward significance, OR 0.47 (P = 0.050).

Conclusion

Laparoscopic surgical management of adhesive SBO was associated quicker GI recovery, shorter LOS, and reduced overall complications compared to open surgery.

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Disclosure

Drs. James Byrne, Fady Saleh, Luciano Ambrosini, Fayez Quereshy, and Timothy Jackson have no conflicts of interest or financial ties to disclose. Dr. Allen Okrainec is a consultant for Covidien and receives honoraria for speaking and teaching.

Funding

No external sources of funding were used for this study.

Author information

Correspondence to James Byrne.

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Byrne, J., Saleh, F., Ambrosini, L. et al. Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 29, 2525–2532 (2015). https://doi.org/10.1007/s00464-014-4015-7

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Keywords

  • Small bowel obstruction
  • Laparoscopy
  • Adhesiolysis