Laparoscopic Versus Open Adhesiolysis for Small Bowel Obstruction

A Multicenter, Prospective, Randomized, Controlled Trial

Ville Sallinen; Heidi Wikström; Mikael Victorzon; Paulina Salminen; Vesa Koivukangas; Eija Haukijärvi; Berndt Enholm; Ari Leppäniemi; Panu Mentula

Disclosures

BMC Surg. 2014;14(77) 

In This Article

Background

Small bowel obstruction (SBO) is a common surgical emergency most frequently caused by adhesions. A large portion of adhesive SBO resolve by nonoperative methods such as fasting and ingestion of an oral contrast-media, while a significant number of patients will need emergency surgery.[1] For decades open surgery has been the gold standard in treating adhesive SBO. Now that laparoscopic surgery has been established as a first line option in many elective indications such as colorectal surgery, fundoplication, and cholecystectomy for example, laparoscopy is emerging also as a viable alternative in emergency surgery.

If SBO is caused by one adhesive band, the surgical treatment is straightforward - cutting the band causing obstruction. Laparoscopic approach seems ideal for such a procedure, preventing the morbidity of a laparotomy incision. First publications describing laparoscopic adhesiolysis in SBO are from the 1990's.[2] Since then several retrospective series have been published, and a recent meta-analysis pooled patients from four studies, including a total of 334 patients.[3] Meta-analysis showed that patients treated by the laparoscopic approach had less complications, and faster return of bowel function.[3] However, there are no prospective randomized trials comparing open approach to laparoscopy. Furthermore, previous retrospective studies have a selection bias because the easiest cases are selected for laparoscopic approach. One of the drawbacks of laparoscopic approach is a concern for iatrogenic bowel perforation. In one report, the rate of bowel lesion in laparoscopic adhesiolysis was 6.6%, and only 84% were detected during the operation.[4]

processing....