The Role of Laparoscopy in the Management of Bowel Obstruction

Abstract

Though laparotomy is the traditional intervention for adhesive small bowel obstruction (SBO), laparoscopy is becoming increasingly accepted and utilized and offers patient advantages in selected cases. Patient history and preoperative imaging are often helpful in determining if the patient is a candidate for a laparoscopic approach. During laparoscopic exploration, initial peritoneal access should be attained away from prior scars, and the bowel should ideally be examined from distal to proximal to identify the point of obstruction, with careful handling of fragile and dilated bowel. Critical goals for surgery include identification and relief of the point of obstruction, resection of nonviable bowel, and avoidance of inadvertent enterotomy. Conversion to open surgery should be undertaken expeditiously when it is determined that one of these goals cannot be safely accomplished laparoscopically. Many studies, though retrospective and not randomized, suggest improved early morbidity with laparoscopic exploration, though with high rates of conversion to open surgery. Conflicting results exist on whether open or laparoscopic exploration carries a higher risk of iatrogenic enterotomy. Further studies are needed to assess how laparoscopic adhesiolysis will impact long-term recurrence SBO.