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Laparoscopic versus open surgery in small bowel obstruction

  • Review
  • Intervention




Acute intestinal obstruction is one of the most common surgical emergencies. The small bowel obstruction (SBO) is the site of obstruction in most patients (76%) and adhesions are the most common etiology (65%). Laparoscopy in SBO has no clear role yet as it may have a therapeutic and diagnostic function. In some settings laparoscopic or laparoscopy-assisted surgery is considered feasible and convenient more than conventional surgery for SBO; however little is known if laparoscopic or laparoscopy-assisted surgery is more suitable with respect to open surgery for patients with SBO.


The aim of this systematic review is to assess whether laparoscopic or laparoscopy-assisted surgery is feasible and safe for acute SBO, and whether laparoscopic and laparoscopy-assisted surgery present advantages compared to open surgery in terms of short-term and long-term outcomes.

Search methods

We searched for published randomised and prospective controlled clinical trials without language restrictions using the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 onwards) and EMBASE (1980 onwards).

Selection criteria

Randomised controlled trials and non randomised controlled prospective trials evaluating laparoscopic and laparoscopy-assisted surgery versus traditional open surgery for acute SBO were considered.

Data collection and analysis

We conducted the review according to the recommendations of The Cochrane Collaboration and the Cochrane Colorectal Group as well, using Review Manager 5 to conduct the review.

Main results

No published or unpublished randomised controlled trials or prospective controlled clinical trials comparing laparoscopy with open surgery for patients with SBO were identified.

Authors' conclusions

Although data from retrospective clinical controlled trials suggest that laparoscopy seems feasible and better in terms of hospital stay and mortality reduction, high quality randomised controlled trials assessing all clinically relevant outcomes including overall mortality, morbidity, hospital stay and conversion are needed.








我們在下列幾個資料庫搜尋了不限語言種類的所有發表過隨機且前瞻性控制的臨床試驗:包括考科藍中央資料庫(Cochrane Central Register of Controlled Trials ),MEDLINE (1950 ~) and EMBASE (1980 ~).




本研究依據考科藍協作組織及考科藍大腸直腸組之建議實施,並使用Review Manager 5 進行審核。





Plain language summary

Should laparoscopic adhesiolysis be used in patients with acute small bowel intestinal obstruction?

Abdominal laparoscopy is a minimally invasive surgical technique in which operations are achieved through incision (usually 2-3 cm) using a laparoscope which is connected to a video camera. Small bowel obstruction is an event that may follow open surgery. According to several studies laparoscopic surgery is technically feasible and safe for the treatment of small bowel obstruction, however little is known about its efficacy in terms of mortality and morbidity.

This review addresses the question if laparoscopic surgery is effective with respect to traditional laparotomy. No randomised controlled trials or prospective controlled clinical trials that compared laparoscopy with laparotomy for small bowel obstruction were identified. Although there was some evidence from case series reports, observational studies and retrospective controlled clinical trial, high quality randomised controlled trials are required on the potential benefit and harms associated with the use of laparoscopy in small bowel obstruction.


腹腔鏡腸沾黏剝離手術是否適用於急性小腸阻塞? 腹腔鏡是一種微創外科技術,使用接上攝影機的腹腔鏡,在小切口(約2-3公分)進行手術。而小腸阻塞過去通常需要開腹式手術治療。許多研究顯示治療此一疾病使用腹腔鏡應該是可行且安全的,但是關於死亡率及併發症比率則仍不清楚。此系統分析原是為評估腹腔鏡是否優於傳統開腹式手術,但目前仍沒有隨機控制試驗或前瞻式控制試驗可供分析比較。即便目前已有回溯性、觀察性研究證實腹腔鏡的優點,我們仍需要優質隨機控制試驗來評估腹腔鏡手術治療小腸阻塞的優缺點。