Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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



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.


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


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.


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).


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

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Sikirica V et al (2011) The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg 11:13. doi:10.1186/1471-2482-11-13

  2. 2.

    Tierris I et al (2011) Laparoscopy for acute small bowel obstruction: indication or contraindication? Surg Endosc 25(2):531–535. doi:10.1007/s00464-010-1206-8 Epub 2010 Jul 7

  3. 3.

    Vettoretto N et al (2012) Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis 14(5):e208–e215. doi:10.1111/j.1463-1318.2012.02968.x

  4. 4.

    Catena F et al (2011) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the World Society of Emergency Surgery. World J Emerg Surg 6(5):21. doi:10.1186/1749-7922-6-5

  5. 5.

    Menzies D (1992) Peritoneal adhesions. Incidence, cause, and prevention. Surg Annu 24(Pt 1):27–45

  6. 6.

    Luijendijk RW et al (1996) Foreign material in postoperative adhesions. Ann Surg 223(3):242–248

  7. 7.

    Kelly KN et al (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(1):65–73. doi:10.1007/s00464-013-3162-6 Epub 2013 Sep 4

  8. 8.

    Bastug DF et al (1991) Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc 1(4):259–262

  9. 9.

    Farinella E et al (2009) Feasibility of laparoscopy for small bowel obstruction. World J Emerg Surg. 4:3. doi:10.1186/1749-7922-4-3

  10. 10.

    Sauerland S et al (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20(1):14–29 Epub 2005 Oct 24

  11. 11.

    Leon EL et al (1998) Laparoscopic management of small bowel obstruction: indications and outcome. J Gastrointest Surg 2(2):132–140

  12. 12.

    Strickland P et al (1999) Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 13(7):695–698

  13. 13.

    Nagle A et al (2004) Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 187(4):464–470

  14. 14.

    Zerey M et al (2007) Laparoscopic management of adhesive small bowel obstruction. Am Surg 73(8):773–778 discussion 778–9

  15. 15.

    Gutt CN et al (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18(6):898–906 Epub 2004 Apr 27

  16. 16.

    Mancini GJ et al (2008) Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg. 207(4):520–526. doi:10.1016/j.jamcollsurg.2008.04.026 Epub 2008 Jun 24

  17. 17.

    Saleh F et al (2014) Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes. Surg Endosc 28(8):2381–2386. doi:10.1007/s00464-014-3486-x Epub 2014 Mar 21

  18. 18.

    Bone RC et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655

  19. 19.

    Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90(9):1147–1151

  20. 20.

    Johnson KN et al (2012) Laparoscopic management of acute small bowel obstruction: evaluating the need for resection. J Trauma Acute Care Surg 72(1):25–30. doi:10.1097/TA.0b013e31823d8365 discussion 30-1; quiz 317

  21. 21.

    Khaikin M et al (2007) Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness. Surg Endosc 21(5):742–746 Epub 2007 Mar 1

  22. 22.

    Okamoto H et al (2012) Clinical outcomes of laparoscopic adhesiolysis for mechanical small bowel obstruction. Asian J Endosc Surg 5(2):53–58. doi:10.1111/j.1758-5910.2011.00117.x Epub 2011 Nov 24

  23. 23.

    Chopra R et al (2003) Laparoscopic lysis of adhesions. Am Surg 69(11):966–968

  24. 24.

    Li MZ et al (2012) Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg. 204(5):779–786. doi:10.1016/j.amjsurg.2012.03.005 Epub 2012 Jul 12

  25. 25.

    Margenthaler JA et al (2006) Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 243(4):456–464

  26. 26.

    Grafen FC et al (2010) Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 395(1):57–63. doi:10.1007/s00423-009-0490-z Epub 2009 Mar 28

  27. 27.

    Kirshtein B et al (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19(4):464–467 Epub 2005 Feb 3

  28. 28.

    Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 21(11):1945–1949 Epub 2007 Sep 19

  29. 29.

    O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc 26(1):12–17. doi:10.1007/s00464-011-1885-9 Epub 2011 Sep 5

  30. 30.

    Levard H et al (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71(11):641–646

  31. 31.

    Suter M et al (2000) Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Surg Endosc 14(5):478–483

Download references


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.


No external sources of funding were used for this study.

Author information

Correspondence to James Byrne.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation


  • Small bowel obstruction
  • Laparoscopy
  • Adhesiolysis