Laparoscopic treatment of acute small bowel obstruction: A multicentre retrospective study
Article first published online: 20 DEC 2001
ANZ Journal of Surgery
Volume 71, Issue 11, pages 641–646, November 2001
How to Cite
Levard, H., Boudet, M.-J., Msika, S., Molkhou, J.-M., Hay, J.-M., Laborde, Y., Gillet, M., Fingerhut, A. and French Association for Surgical Research (2001), Laparoscopic treatment of acute small bowel obstruction: A multicentre retrospective study. ANZ Journal of Surgery, 71: 641–646. doi: 10.1046/j.0004-8682.2001.02222.x
8 av des Peupliers, 92270 Bois Colombes, France.
- Issue published online: 20 DEC 2001
- Article first published online: 20 DEC 2001
- Accepted for publication 14 July 2001.
- acute small bowel obstruction;
- late complications;
- postoperative complications;
- predictive factors;
- univariate analysis
Background: Laparoscopic surgery is thought to promote early recovery and quicker return to bowel function. The objective was to evaluate the rate and predictive factors of success, the causes of failure, the morbidity, and mortality during and after hospitalization, as well as to determine whether laparoscopic treatment of acute small bowel obstruction offers the same benefits as for other laparoscopic procedures.
Methods: The records of 308 patients with acute small bowel obstruction treated laparoscopically in 35 centres between 1 October 1988 and 30 September 1996 were retrospectively reviewed.
Results: Treatment was implemented completely by laparoscopy (‘success’ group) in 168 patients (54.6%). Conversion to laparotomy (‘failure’ group) was required in 140 patients (45.4%; during the same operation in 126 patients and after a median delay of 4 days (range: 1–12 days) in 14 patients). There were significantly more successes in patients with a history of one or two surgical interventions than in those with more than two (56%vs 37%; P < 0.05). There were significantly more successes in patients who had undergone appendectomy only (67/94; 71%) than in patients who (i) had no antecedent surgery (52%; P < 0.05), or (ii) underwent other surgery (33%; P < 0.001). The rate of success was significantly higher (P < 0.001) in patients operated on early (< 24 h) and in patients with bands (54%), than in those with adhesions (31%) or with other causes of obstruction (15%). The median duration of postoperative ileus was significantly shorter in the ‘success’ group than in the ‘failure’ group (2 days vs 4 days; P < 0.001). The median duration of postoperative hospital stay was shorter in the ‘success’ group than in the ‘failure’ group (4 days vs 10 days; P < 0.001). Fewer immediate wound complications were sustained in the ‘success’ group than in the ‘failure’ group (1.2%vs 10.7%; P < 0.001). The total number of immediate or delayed complications and particularly the number of recurrent obstructions after hospitalization as well as the number of deaths did not differ significantly between the two groups.
Conclusions: Successful laparoscopic treatment of small bowel obstruction can be expected in patients who are seen early, and who have had one or two previous interventions (particularly appendectomy, especially if bands are found).