COMMENTARY

How Safe Is Laparoscopic Surgery for Adhesive Small Bowel Obstruction?

Albert B. Lowenfels, MD

Disclosures

November 30, 2017

Is open abdominal surgery preferable to laparoscopic surgery for management of small bowel obstruction? The authors of a paper, published in Annals of Surgery,[1] looked at data from 8584 Canadian patients treated for small bowel obstruction during the years 2005 to 2014.

Complication rates (operative and postoperative) were compared for the two alternative surgical approaches. Bowel intervention, which included repair or resection of injured bowel, was more frequent in the laparoscopic group (odds ratio, 1.64; P = .0001). In contrast, 30-day mortality was 47% lower in the laparoscopic group (odds ratio, 0.63; P = .03).

Viewpoint

An acute abdomen caused by bowel obstruction is a frequent cause of hospitalization, so that the most appropriate operative approach becomes an important issue for surgeons. This report found that bowel injury was significantly more frequent with laparoscopy and may be related to the potential risk of inserting a trocar into a distended abdomen.

But the report reveals a dilemma—30-day mortality was substantially lower in the laparoscopy group. Because this was not a randomized trial, patient selection and differential preoperative patient morbidity may be responsible for the mortality difference.

As pointed out in the discussion, before deciding on a laparoscopic approach, the surgeon should be aware of the increased risk for bowel injury; in selected patients, an open approach may be the best option. Although not discussed in this manuscript, it will be interesting to see if the overall frequency of intestinal obstruction diminishes now that so many abdominal procedures employ a laparoscopic approach with a much smaller abdominal wall scar.

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