Laparoscopic management of acute small bowel obstruction

Keys to successful laparoscopic adhesiolysis for adhesive small bowel obstruction: A scoping review

Background

Adhesive small bowel obstruction (ASBO) is a common acute abdominal complication. Although non-surgical treatment is the primary treatment approach, more and more studies show that surgical treatment can reduce the incidence rate. Laparoscopic adhesiolysis (LA) has many advantages of minimally invasive surgery.But not all patients with ASBO are suitable for LA.

Objective

The aim of this scoping review was to summarize the keys to successful LA by analyzing the extensive literature.

Methods

A literature search was conducted in PubMed for articles on laparoscopic treatment of ASBO published between January 2000 and February 2024. This scoping review followed the framework suggested by Arksey and O'Malley for a scoping review.

Results

By analyzing the included studies we found that LA does have many advantages and can be performed safely. However, the prerequisite is to select patients with simple adhesions whenever possible and to focus on reasonable intraoperative measures. To improve the success rate of LA, we summarized the following characteristics of patients: no contraindications related to pneumoperitoneum, few previous abdominal operations (≤2), no pregnancy, bowel dilatation < 4 cm in diameter, simple adhesions, no diffuse peritonitis, no history of abdominal radiotherapy, <24 h of ASBO, limited previous abdominal surgery (appendix, cholecystectomy), no bowel strangulation ischemia, and bowel necrosis or bowel resection required for other reasons. In addition, we also summarized reasonable intraoperative measures.

Conclusions

Laparoscopic adhesiolysis has many advantages.Specific patients can benefit from LA. This scoping review Summarized the conditions for patient screening and reasonable intraoperative measures with the aim of providing a reference for surgeons, thereby ensuring that more patients benefit from LA.

Adhesive small bowel obstruction: predictive factors of laparoscopic failure

The adoption of laparoscopy for the management of adhesive small bowel obstruction (ASBO) patients is debated. The laparoscopic approach has been associated with a considerable conversion-to-open rate. Nonetheless, reliable predictors of conversion are still unclear. The present study aimed to identify factors associated with conversion to open in ASBO patients who underwent laparoscopic surgery. Patients who underwent laparoscopic surgery for ASBO and were admitted to our unit between December 2014 and October 2022 were retrospectively evaluated. The patients were categorized into two groups: patients who underwent complete laparoscopy approach (Group 1) and patients converted to open technique (Group 2). Demographic, clinical, and radiological features, intraoperative findings, and postoperative outcomes were compared. A total of 168 patients were enrolled: 100 patients (59.5%) were included in Group 1, and 68 patients (40.5%) were included in Group 2. The rate of ischemia (p = 0.023), surgical complications (p = 0.001), operative time (p < 0.0001), days of nasogastric tube maintenance (p < 0.0001), time to canalization (p < 0.0001), and length of hospital stay (p < 0.0001) were significantly higher in Group 2 than Group 1. Following univariate analysis, the presence of feces signs (p = 0.044) and high mean radiodensity of intraperitoneal free fluid (p = 0.031) were significantly associated with Group 2 compared with Group 1. Following multivariate analysis, the feces sign was a significant predictive factor of conversion (OR 1.965 [IC 95%]; p = 0.046). Laparoscopic treatment is a safe and effective approach in patients affected by ASBO. The feces sign may be a predictive factor of conversion and could guide the surgeon in selecting the appropriate management of patients affected by ASBO.

Individualization of the best approach for adhesive small bowel obstruction

BACKGROUND

Laparoscopic postoperatives outcomes in adhesiolysis are promising but conversion and morbidity remains high. The objective of our study was to determine preoperative factors to individualize and select the most appropriate approach for each patient.

METHODS

Patients ≥18 years old undergoing emergent surgery for adhesive small bowel obstruction and internal hernias were evaluated. Bivariate and multivariate analysis were performed to investigate factors related to conversion to open surgery and to the type of adhesions.

RESULTS

Of 333 patients, 224 were operated by laparotomy and 109 by laparoscopy (conversion rate: 40%). Previous abdominal wall mesh, type of adhesions, bowel lesion, need for intestinal resection and laparoscopic skills were statistically related to conversion. In the multivariate analysis, complex adhesions (OR 4.3, 95% CI 1.5-12.2; P = 0.006), the need for intestinal resection (OR 14.16, 95% CI 2.55-78.68; P = 0.002), and non-advanced laparoscopy surgeons (OR 4.31, 95% CI 1.56-11.94; P = 0.005) were independent factors for conversion to open surgery. ASA III-IV, previous surgeries, previous abdominal mesh and previous adhesiolysis were related to complex adhesions. Previous laparoscopic surgery and internal hernia or closed loop in computed tomography were associated with simple adhesions as a cause of the obstruction. In the multivariate, previous adhesiolysis (OR 4.76, 95% CI 1.23-18.3; P = 0.023) and the findings on computed tomography were significantly related with the type of adhesion.

CONCLUSION

Some preoperative factors allow to individualize the surgical approach in the adhesive small bowel obstruction improving surgical outcomes.

Bezoar at Jejunojejunostomy Following Liver Transplant: A Case Report

During pediatric liver transplant, biliary reconstruction is often performed using Roux-en-Y choledoc-hojejunostomy or hepaticojejunostomy due to size mismatch, excessive tension caused by distance between donor and recipient ducts, or for transplant to treat primary biliary pathology. This method can be associated with additional small bowel-related complications compared with end-to-end ductal anastomosis. We report a case of late small bowel obstruction secondary to an impacted bezoar that formed at a patulous jejunojejunostomy portion of the biliary-enteric anastomosis. The patient was a 26-year-old male patient, who underwent deceased donor whole liver transplant for pediatric acute liver failure. Prior to his presentation to our institution with 2 days of abdominal pain, nausea, persistent burping, and intermittent vomiting, the patient reported an uneventful posttransplant course and was followed up at the institution where his transplant was performed. There were no reported changes in diet or lifestyle and no similar episodes during his follow-up. The patient was managed surgically after a brief trial of nonoperative management. At laparotomy, the anastomosis was resected and reconstructed to improve enteric drainage and prevent recurrent bezoar formation. The patient was discharged with no postoperative complications and remained asymptomatic at 11 months follow-up. We describe the clinical course and our technical approach at initial choledochojejunostomy creation and at jejunojejunostomy revision.

RYGB-Induced Gut Dysmotility and Retrograde Intussusception: an Unusual Phenomenon. A Narrative Literature Review

Intussusception following Roux-en-Y gastric bypass (RYGB) is a rare complication of bariatric surgery with an unclear etiology. The pathogenesis underlying intussusception after gastric bypass is likely different from that in the general population. Post-RYGB intussusception might be related to motility issues in the divided small bowel, thinning of the mesentery following rapid weight loss, or anastomotic sutures/staple line acting as the lead point. This condition can cause obstruction with subsequent strangulation and bowel necrosis if not recognized and treated promptly. Clinical presentation is vague and nonspecific, and computerized tomography scan represents the diagnostic test of choice. Surgical treatment consists of reduction with or without anastomosis resection and reconstruction. This literature review provides an extensive overview of this condition, based on multiple studies involving 120 patients.

Internal hernia caused by bridge formation between the medial and lateral segments of the liver: a case report

BACKGROUND

Despite numerous reports on ischemic bowel obstruction caused by internal hernia, no case presentation has been reported of an internal hernia caused by a bridge formed between the medial and lateral zones of the liver. Herein, we report the first case of ischemic bowel obstruction caused by a hepatic bridge.

CASE PRESENTATION

A 24-year-old man complaining of abdominal pain was referred to our hospital and admitted. Computed tomography showed formation of a closed loop of small bowel with a hernia orifice near the hilar region, and poor contrast of the prolapsed small bowel. We suspected ischemic bowel obstruction caused by an internal hernia with a fissure of the greater omentum as the hernia orifice, and performed emergency surgery. Laparoscopic observation revealed that the medial and lateral segments of the liver formed a bridge on the dorsal side at the liver portal, and that the small intestine was ischemic in the gap created between the bridge and the medial and lateral liver segments. A Meckel's diverticulum was also invaginated in the gap. The bridge was dissected out and the hernia orifice was opened to release the bowel obstruction. The small bowel was preserved and the Meckel's diverticulum was resected. The patient's postoperative course was uneventful.

CONCLUSIONS

We experienced a case of ischemic bowel obstruction caused by hepatic bridge formation, which was successfully treated by laparoscopic surgery.

Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report

Background

Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS).

Case presentation

A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications.

Conclusions

We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.

A Case of Sigmoid Colon Cancer Prolapsed Through the Anus in a Young Woman

Introduction

Intussusception in which colon cancer acts as a lead point has been previously reported in a number of cases, but prolapse of the tumor through the anus has rarely been reported, and most of those few previous reports have involved elderly individuals.

Case presentation

The patient in this case was a 26-year-old Japanese woman who presented to our emergency department with severe pain after her intestinal tract prolapsed through the anus during defecation. The intussusception was released laparoscopically, and we were able to perform complete mesocolic excision in a manner similar to conventional laparoscopic sigmoidectomy for sigmoid colon cancer prolapse through the anus in a young woman. Because liver metastases were identified on computed tomography, the patient underwent partial hepatectomy twice.

Conclusion

The patient has been followed up for 8 years since the initial surgery and remains alive without recurrence.

Small bowel obstruction after caesarean section: Laparoscopic management. Two case reports

INTRODUCTION

Caesarean section is the most common abdominal surgery performed on women worldwide. Adhesions represent a severe complication of cesarean section and can cause different degrees of bowel obstruction.

CASE REPORTS

We report two unusual cases of small bowel obstruction treated with laparoscopic approach after caesarean section performed for gynecological pathologies. In the first one small bowel obstruction was due to volvulus caused by a severe pelvic adhesion syndrome; in the second one, occlusive picture was related to presence of multiple adhesion phenomena between the sigmoid colon and the right ovary as result of abdominal hysterectomy.

DISCUSSION

The incidence of small bowel obstruction after caesarean section is very low and postoperative adhesions represent the main cause. Diagnosis was established by clinical signs, radiological and intraoperative findings. Laparoscopic approach can be the treatment of choice only in selected patients. In presence of dense adhesions, inability to visualize the site of obstruction, iatrogenic intestinal perforation, bowel necrosis and technical difficulties, conversion to open surgery is mandatory.

CONCLUSION

In selected patients with small bowel obstruction laparoscopy is a safe and feasible procedure if conservative measures fail.

Laparoscopic treatment of a pericaecal internal hernia

We present the case of a pericaecal hernia treated successfully with a laparoscopic approach and full recovery after surgery. A 53-year-old female patient with a personal history of depression, osteoporosis and irritable bowel syndrome consulted to the emergency department for abdominal pain and distension in the last 12 h, associated with one episode of vomit and diminished frequency in the passage of stools. The right abdomen was tender to palpation, and blood work revealed no leucocytosis. A computed tomography scan showed small bowel loops distended and displaced to the right parietocolic recess, lateral to the ascending colon. Exploratory laparoscopy was performed confirming the presence of small bowel loops incarcerated in the paracaecal fossa. These ones were reduced with gentle manoeuvres, and the peritoneal folds incised to prevent recurrence. The patient was started on an oral diet 2 days after surgery and discharged home on the 3^rd post-operative day.

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal (GI) tract. They consist of vegetable or fruit fibers, hairs or other substances; accordingly, bezoars are classified as phytobezoars, trichobezoars, pharmacobezoars, etc. Although sometimes asymptomatic, bezoars may cause serious symptoms, such as abdominal discomfort or pain, dysphagia, hematemesis, or even life-threatening entities (GI bleeding, obstruction or perforation). Current technological applications have contributed to the diagnostic and therapeutic approach to these masses, mainly through endoscopic techniques able to diagnose, fragment and extract bezoars, as well as laparoscopic and other surgical modalities that may be used to treat serious complications. Although bezoars were described centuries ago and the term was officially introduced in the mid nineties by Quain, they are still a demanding pathological entity. Their pathophysiology, accurate and prompt diagnosis, as well as successful and minimally invasive treatment, remain under investigation and see continuous progress. Current advances in these challenging areas are discussed in this review, which attempts to present an in-depth study of bezoars along with the well-established modalities and techniques.

Band adhesions not related to previous abdominal surgery - A retrospective cohort analysis of risk factors

Background

Postoperative intra-abdominal adhesion formation is a common cause of small bowel obstruction (SBO). Adhesions causing SBO are classed as either matted adhesions or solitary band adhesions. The aim of this study was to investigate the prevalence of previous abdominal surgery in a cohort of patients operated for bowel obstruction and to analyze the causes of obstruction discovered at surgery.

Materials and methods

The study was performed at a county hospital with a catchment population of 120 000 inhabitants. Records of operations performed for bowel obstruction over a period of 70 months were retrieved.

Results

Of the 196 surgical procedures for intestinal obstruction included, 108 (55%) were caused by adhesions. In this group, 42 (39%) were due to solitary band adhesions and 66 (61%) were due to matted adhesions. Ten of 18 male patients (56%) with a solitary obstructing band had not undergone previous abdominal surgery (p < 0.05). In the cohort as a whole, a significant number of surgical procedures were performed for solitary band adhesions in patients without prior history of surgery (p < 0.01).

Conclusion

In male patients, not only previous abdominal surgery but also other factors appear to increase the risk for bowel obstruction due to a solitary band. For intestinal obstruction caused by matted adhesions, however, previous abdominal surgery is the main risk factor in both genders. Patients with signs of SBO but without previous abdominal surgery should be managed bearing in mind that solitary band adhesion and thereby strangulation may be present regardless of previous surgery or not.

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Post-operative abdominal adhesions are a common reason for small bowel obstruction.

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Abdominal adhesions can develop without undergoing previous surgery.

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Band adhesions occurs without prior surgery – gender seems to be of importance.

Laparoscopic treatment of intestinal obstruction due to a vitelline vascular remnant and simultaneous appendicitis: a case report

BACKGROUND

The presence of a vitelline vascular remnant is rare, and definitive preoperative diagnosis is difficult. We herein describe a case of intestinal obstruction caused by a vitelline vascular remnant with mild chronic appendicitis successfully diagnosed and treated with laparoscopic surgery.

CASE PRESENTATION

A 14-year-old male was admitted to our hospital with sudden-onset right lower abdominal pain and vomiting. A blood test on admission revealed slight leukocytosis. Computed tomography scan showed that the appendiceal wall was enhanced and thickened. Although the ileum was slightly dilated and ascites was present at the recto-vesical pouch, these were thought to be inflammatory changes secondary to appendicitis. Laparoscopic surgery was performed using three trocars. Strangulated small bowel obstruction caused by a band connecting the right medial umbilical fold to the ileal mesentery was found intraoperatively. After reduction, neither ischemic change of the small intestine nor Meckel's diverticulum was detected. The appendix was slightly inflamed, and serous ascites was present at the recto-vesical pouch; therefore, appendectomy was also performed. The patient was discharged on postoperative day 4 without complications. Pathological examination revealed that the band consisted of blood vessels, and it was diagnosed as a vitelline vascular remnant. The appendix included fecal stones and showed chronic inflammatory change histologically; the patient was thus diagnosed with chronic appendicitis.

CONCLUSIONS

Definitive preoperative diagnosis of a vitelline vascular remnant, especially with coexisting appendicitis, might be difficult. Laparoscopic surgery might be useful for patients who demonstrate unusual symptoms because it allows for simultaneous diagnosis and treatment.

A rare case of secondary small bowel volvulus laparoscopically repositioned: literature review and classification

Background

Secondary small bowel volvulus is a rare condition caused by adhesions after laparotomy or tumors. There are no clear guidelines for indication of laparoscopic surgery.

Case presentation

A 69-year-old male visited our hospital complaining of epigastric pain. He had a history of hypopharyngeal carcinoma treated via pharyngolaryngoesophagectomy with restoration of esophageal continuity by harvesting a free jejunal autograft 6 years ago.

Enhanced computed tomography revealed the whirl sign. An emergency laparoscopic operation was performed following a diagnosis of small bowel volvulus. This revealed rotation of the whole small bowel, involving the superior mesenteric artery as the center, and originating at the adhesion of the proximal and distal small bowel. Laparoscopic manipulation of volvulus and lysis of the adhesion were performed. The patient’s postoperative course was uneventful, and he was discharged on hospital day 5.

Conclusions

Laparoscopic surgery may be useful for treating small bowel volvulus; however, the patient’s treatment indications should be judged carefully.

Laparoscopic two-stage procedure for gallstone ileus

Gallstone is a rare cause of bowel obstruction and is associated with high rates of morbidity and mortality. Here, we report a case of gallstone ileus treated by laparoscopic two-stage procedure. A 65-year-old man, without a history of any surgery, presented to our hospital with abdominal pain and vomiting. His abdominal computed tomography revealed gallstone ileus with cholecystoduodenal fistula. Then, enterolithotomy was performed as an emergency laparoscopic surgery. After 1 year of the surgery, a second laparoscopic procedure was performed for cholecystectomy and fistula closure. The patient was discharged on the 7^th postoperative day. Laparoscopic two-stage procedure is a safe and an efficient approach for the management of gallstone ileus. This definitive treatment is minimally invasive, thereby suitable for treating elderly patients.

Safety and Indications of Laparoscopic Surgery for Postoperative Small-bowel Obstruction: A Single-center Study of 121 Patients

BACKGROUND/AIMS

The purpose of this study was to evaluate the safety and effectiveness of laparoscopic surgery for the treatment of small-bowel obstruction.

MATERIALS AND METHODS

The study group comprised 121 patients who underwent laparoscopic surgery for small-bowel obstruction.

RESULTS

Previous operations were open surgery in 107 patients and laparoscopic surgery in 14. On univariate analysis, 4 risk factors were related to conversion to open surgery: radiotherapy (P=0.0002), previous episode of intestinal obstruction (P=0.0064), bleeding volume of ≥50 mL (P=0.0059), and the presence or absence of previous bowel resection (P=0.0269). On multivariate analysis, only radiotherapy was an independent risk factor for conversion to open surgery (odds ratio, 5.5141; P=0.0091).

CONCLUSIONS

Laparoscopic surgery can be safely performed in patients with postoperative small-bowel obstruction and is considered an effective treatment with a low rate of recurrent bowel obstruction.

Two patients with spontaneous transomental hernia treated with laparoscopic surgery: a review

Here, we report two patients with transomental hernia who were successfully treated with laparoscopic surgery. The first patient was a 58-year-old female who presented to our hospital with abdominal pain and vomiting; she had no history of abdominal surgery. Enhanced computed tomography revealed strangulation ileus due to an internal hernia. The second patient was a 36-year-old male who presented to our hospital with abdominal pain and no history of abdominal surgery. Enhanced computed tomography indicated transomental hernia. Emergency laparoscopic surgery in both patients revealed incarcerated bowel loops through defects in the greater omentum. The bowel segments were laparoscopically released, and the patients were uneventfully discharged on postoperative Days 4 and 8. Laparoscopic surgery is useful for the diagnosis and treatment of small bowel obstruction due to transomental hernia through the greater omentum.

Paracecal hernia with intestinal ischemia treated with laparoscopic assisted surgery

INTRODUCTION

Paracecal hernia is rare, and strangulation with ischemia has been infrequently observed in the limited number of published reports on paracecal hernias.

PRESENTATION OF CASE

We describe a case of an incarcerated paracecal hernia with resultant ischemic bowel that was successfully treated with laparoscopic-assisted surgery. A 54-year-old man who had not undergone any surgery previously presented to our hospital with abdominal pain and vomiting. An abdominal computed tomographic scan showed evidence of an intestinal obstruction at a paracecal site. An emergency laparoscopic surgery demonstrated incarceration of a loop of the small bowel in the paracecal fossa. We removed the incarcerated small bowel from the paracecal fossa, noted that the tissue was necrotic, and resected this segment of bowel through a mini-laparotomy incision. The patient was discharged on the 13th postoperative day.

DISCUSSION AND CONCLUSION

This case is unique in that the patient presented with small bowel strangulation, causing intestinal ischemia. Laparoscopic surgery is useful in the diagnosis of internal hernias and is also useful for the treatment of small bowel obstruction due to paracecal hernias complicated by ischemic bowel.

Retrocecal hernia preoperatively diagnosed by computed tomography: A case report

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A retrocecal hernia is a rare type of pericecal hernia.

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The genesis of retrocecal hernias is explained based on the minimal error in rotation with incarceration behind the cecum.

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Abdominal computed tomography scan is useful for preoperative diagnosis of retrocecal hernia.

Introduction

Retrocecal hernia is a rare type of pericecal hernia. Because it is difficult to diagnose preoperatively, it is often treated with emergency operation.

Case presentation

An 83-year-old male patient experienced sudden abdominal pain. Marked small bowel dilatation and intestinal obstruction were detected by abdominal computed tomography (CT). An enhanced CT scan also revealed a trapped cluster of small bowel loops behind the cecum and ascending colon. We preoperatively diagnosed small bowel ileus as a result of retrocecal hernia. After conservative therapy with a long intestinal tube, an emergency operation was performed. During the surgery, a portion of the ileum was found to be incarcerated in the retrocecal fossa. Intestinal resection was not necessary because the incarcerated ileum appeared viable, and the orifice to the hernia was opened. The patient was discharged without postoperative complications.

Discussion

The diagnosis of retrocecal hernia can often be confirmed intraoperatively. This disease is identified based on a minimal error in rotation with incarceration behind the cecum during the final phase of descent and fixation of the right colon or failure of cecal and retroperitoneal fixation. Early preoperative diagnosis is important to prevent intestinal ischemia, necrosis, and perforation and to reduce resection rates.

Conclusion

Early preoperative diagnosis is important to avoid resection of the small intestine. CT scans are useful for preoperative diagnosis in case of retrocecal hernia.

Laparoscopic Versus Open Adhesiolysis for Small Bowel Obstruction: A Single-Center Retrospective Case-Control Study

AIM

This study is to investigate the short-term outcomes of small bowel obstruction (SBO) patients undergoing laparoscopic versus open adhesiolysis.

PATIENTS AND METHODS

A total of 202 patients with SBO were enrolled in this study. The patients underwent either laparoscopic (n=101) or open adhesiolysis (n=101). The primary end point was 30-day overall complications and secondary outcomes included major complications such as superficial and deep wound infections, mortality, postoperative length of stay, and operative time.

RESULTS

There was no statistically significant difference in the demographic parameters between laparoscopic and open adhesiolysis populations. The mean operative time for laparoscopic adhesiolysis was significantly less than open adhesiolysis (70±34.2 vs. 101±50.2, P=0.01). Statistically significant differences in flatus day (3.5±1.2 vs. 4.5±1.8, P=0.035) and postoperative hospital stay (6.4±2.1 vs. 7.2±2.9, P=0.041) were identified in favor of laparoscopic group, whereas the medical expenses for both groups were not different (31012.0±3412.9 vs. 30029.0±3100.9, P>0.05). The overall complications for open and laparoscopic group were 19.8% and 9.9%, respectively (P=0.048). The important factors that led to a significantly lower overall complications rate in laparoscopic group might result from the lower wound (9.9% vs. 2.0%, P=0.017) and infectious (10.9% vs. 3.0%, P=0.027) complications.

CONCLUSIONS

The laparoscopic approach for SBO is feasible because of its fewer complications and hospital stay.

Decision Making in Bowel Obstruction: A Review

Over the last century there have not been significant changes in the anatomical location of obstruction. The age of presentation has increased along with age related co-morbidity. Management has consequently been challenging as risks keep on increasing with advanced age. Hence, clear decision making has become essential in its management. A selective review of the literature pertaining to common age related aetiologies, diagnosis methods leading to standard decision making and treatment of acute intestinal obstruction was done. The same is obtained from randomized controlled studies, meta-analysis and other related evidence based publications. Predicting the conservative or operative management of Bowel Obstruction (BO) is difficult. BO in young age, in unscarred abdomen and Large Bowel Obstruction (LBO) needs early surgery. Decision on surgery should be taken in paediatric patient by second day and preferably between 3-5 days of admission in adults. Higher American Society of Anaesthesiologists (ASA) grade correlates well with the mortalities. In this article, the timing of surgery, methods to avoid bowel resection and type of surgery in various causes are stressfully analysed and discussed.

Laparoscopic Surgery is Useful for Preventing Recurrence of Small Bowel Obstruction After Surgery for Postoperative Small Bowel Obstruction

INTRODUCTION

Risk factors for recurrence postoperative small bowel obstruction in patients who have postoperative abdominal surgery remain unclear.

MATERIALS AND METHODS

The study group comprised 123 patients who underwent surgery for ileus that developed after abdominal surgery from 1999 through 2013. There were 58 men (47%) and 65 women (53%), with a mean age of 63 years (range, 17 to 92 y). The following surgical procedures were performed: lower gastrointestinal surgery in 47 patients (39%), gynecologic surgery in 39 (32%), upper gastrointestinal surgery in 15 (12%), appendectomy in 9 (7%), cholecystectomy in 5 (4%), urologic surgery in 5 (4%), and repair of injuries caused by traffic accidents in 3 (2%). Laparoscopic surgery was performed in 75 patients (61%), and open surgery was done in 48 (39%). We examined the following 11 potential risk factors for recurrence of small bowel obstruction after surgery for ileus: sex, age, body mass index, the number of episodes of ileus, the number of previously performed operations, the presence or absence of radiotherapy, the previously used surgical technique, the current surgical technique (laparoscopic surgery, open surgery), operation time, bleeding volume, and the presence or absence of enterectomy.

RESULTS

The median follow-up was 57 months (range, 7 to 185 mo). Laparoscopic surgery was switched to open surgery in 11 patients (18%). The reason for surgery for postoperative small bowel obstruction was adhesion to the midline incision in 36 patients (29%), band formation in 30 (24%), intrapelvic adhesion in 23 (19%), internal hernia in 13 (11%), small bowel adhesion in 20 (16%), and others in 1 (1%). Postoperative complications developed in 35 patients (28%): wound infection in 12 (10%), recurrence of postoperative small bowel obstruction in 12 (10%), paralytic ileus in 4 (3%), intra-abdominal abscess in 3 (2%), suture failure in 1 (1%), anastomotic bleeding in 1 (1%), enteritis in 1 (1%), and dysuria in 1 (1%). Enterectomy was performed in 42 patients (38%). On univariate analysis, 2 risk factors were significantly related to the recurrence of small bowel obstruction: open surgery (P=0.017) and bleeding volume (P=0.031). On multivariate analysis, open surgery was an independent risk factor for the recurrence of small bowel obstruction (odds ratio, 5.621; P=0.015).

CONCLUSIONS

Open surgery was an independent risk factor for the recurrence of small bowel obstruction after abdominal surgery. In the future, laparoscopic surgery should be performed to prevent the recurrence of small bowel obstruction.

Laparoscopy for bowel obstruction--a contradiction? Results of a multi-institutional survey in Germany

PURPOSE

The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals.

METHODS

To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care.

RESULTS

Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %.

CONCLUSIONS

This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.

Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus

A single incisional laparoscopic surgery (SILS) approach is increasingly being used, taking advantage of the minimally invasive technique. The aim of this study was to evaluate the feasibility and the validation of SILS procedure for small bowel obstruction (SBO). Sixteen consecutive patients with SBO who underwent SILS release of ileus between April 2010 and March 2015 were compared with the conventional multiport laparoscopic treatment group of 16 patients matched for age, gender, and surgical procedure. Laparoscopic treatment was completed in a total of 14 patients in SILS group and 13 in multiport laparoscopic group. Two cases and 3 cases were converted to multiport laparoscopic surgery or open surgery. Eight patients with nonscar and nonadhesive ileus, such as internal hernia, obturator hernia, gallstone ileus, and intestinal invagination, were treated successfully in the laparoscopic procedure. There was no mortality in either of the groups. The mean procedural time was 105  minutes in the SILS group and 116  minutes in the multiport laparoscopic group. The mean amount of blood loss was not statistically different in either of groups (15  ml vs. 23  ml). Patients resumed oral intake after a mean of 2 days in the SILS and 3 days in the multiport groups with the statistically difference. The length of hospital stay was shorter in the SILS group (5 days vs. 7 days) with no statistically difference. Perioperative morbidity was seen in 2 patients in the SILS group and 3 patients in the multiport group. SILS approach has superior and/or similar perioperative outcomes to multiport approach for SBO. SILS release of ileus as an ultra-minimal invasion technique is feasible, effective, and offers benefits with cosmesis in simple adhesive or scar-less nonadhesive ileus patients.

Retrocecal hernia successfully treated with laparoscopic surgery: A case report and literature review of 15 cases in Japan

INTRODUCTION

Retrocecal hernia is rare and involves strangulation ileus, and therefore, frequently requires emergency surgery following conservative therapy.

PRESENTATION OF CASE

We report an interesting case of a retrocecal hernia in a 65-year-old man, with a history of diabetes mellitus. The patient was admitted to our hospital with severe periumbilical pain and nausea. Abdominal computed tomography revealed an intestinal obstruction at a pericecal site, and dilatation of the small bowel at the oral side of the obstruction. The patient was initially treated with conservative therapy using long intestinal tube placement. On the 12th hospital day, the patient's symptoms had not resolved, and laparoscopic surgery was performed. We diagnosed a retrocecal hernia based on laparoscopic findings and repaired it. The patient was discharged without complications on the 7th postoperative day.

DISCUSSION AND CONCLUSION

Using laparoscopic exploration and suturing, we were able to perform a minimally invasive operation that may have promoted an earlier hospital discharge.

Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes

BACKGROUND

Laparoscopic management of adhesive small bowel obstruction (SBO) has become an established technique within the domain of acute care surgery. As minimally invasive management of SBO becomes more widely accepted, there is increased need for reporting of outcomes.

OBJECTIVE

To compare outcomes of laparoscopic versus open surgery for adhesive SBO.

METHODS

Patients undergoing surgery for adhesive SBO at our institution between 2005 and 2013 were eligible for inclusion. The primary outcome was overall complication rate, while secondary outcomes included operative time, gastrointestinal (GI) function, and postoperative length of stay (LOS). Univariable analysis compared laparoscopic (including conversions) and open groups with regard to patient baseline and perioperative characteristics as well as outcomes of interest. Multivariable analysis was performed comparing the endpoint of overall complications between groups. Sensitivity analysis excluding patients who underwent bowel resection was performed to assess effect on outcomes. Factors associated with laparoscopic success, as well as impact of conversion to open on postoperative outcomes, are reported.

RESULTS

A cohort of 269 patients with adhesive SBO was identified: 186 patients (69.1%) underwent open surgery, 83 (30.9%) were managed laparoscopically. Within the laparoscopy group, 32 (38.6%) underwent conversion to open. Operative time was similar between groups (P = 0.506), while laparoscopy was associated with quicker recovery of GI function indicated by removal of nasogastric tube (P = 0.031) and passage of flatus (P = 0.005). Postoperative LOS was shorter (5 vs. 7 days, P = 0.031) with laparoscopy. The overall complication rate was significantly lower in the laparoscopic group (27.7 vs. 43.6%, P = 0.014), with an adjusted odds ratio (OR) for overall complications of 0.37 (P = 0.002). Following exclusion of bowel resections, secondary outcomes continued to favor laparoscopy, while reduction in overall complications trended toward significance, OR 0.47 (P = 0.050).

CONCLUSION

Laparoscopic surgical management of adhesive SBO was associated quicker GI recovery, shorter LOS, and reduced overall complications compared to open surgery.

Single-port laparoscopic treatment of small bowel obstruction

BACKGROUND

The aim of this study was to report our initial experience with single-port laparoscopic surgery (SPLS) for small bowel obstruction (SBO).

METHODS

Between October 2009 and April 2013, 36 patients underwent SPLS for SBO. SPLS was performed transumbilically. Patient demographics and operative and postoperative outcomes were analyzed.

RESULTS

SPLS for SBO was successful in 35 patients. In 1 patient, a conversion to laparotomy was required. The median incision length, operative time, and postoperative length of stay were 2.3 cm (range, 1.5 to 5.0 cm), 115 min (range, 30 to 250 min), and 8 days (range, 3 to 26 days), respectively. The median time to resume oral intake was 3 days (range, 1 to 16 days). The intra- and postoperative complication rates were 6% and 11%, respectively.

CONCLUSION

SPLS was a safe and feasible therapeutic approach for SBO and may also be an excellent diagnostic tool when performed by an experienced SPLS surgeon in selected patients.

Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias

INTRODUCTION

Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO).

PATIENTS AND METHODS

From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required.

RESULTS

The mean age of the 33 patients who underwent surgery was 61.1 ± 17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83 ± 44 min. and 7.8 ± 11.2 days, respectively. Operative time (72 ± 30 vs 123 ± 63 min.), tolerance to oral intake (1.8 ± 0.9 vs 5.7 ± 3.3 days) and length of postoperative stay (4.7 ± 2.5 vs 19.4 ± 21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group.

CONCLUSIONS

In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short hospital length of stay and low morbidity); its use would be fully justified in these cases.

Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications

INTRODUCTION

Small-bowel obstruction (SBO) requiring adhesiolysis is a frequent and costly problem in the United States with limited evidence regarding the most effective and safest surgical management. This study examines whether patients treated with laparoscopy for SBO have better 30-day surgical outcomes than their counterparts undergoing open procedures.

METHODS

Patients with a diagnosis of adhesive SBO were selected from the ACS National Surgical Quality Improvement Program database from 2005 to 2010. Cases were classified as either laparoscopic or open adhesiolysis groups using Common Procedural Terminology codes. Chi square and Student's t test were used to compare patient and surgical characteristics with 30-day outcomes, including major complications, incisional complications, and mortality. Factors with p < 0.1 were included in the multivariable logistic regression for each outcome. A propensity score analysis for probability of being a laparoscopic case was used to address residual selection bias. A two-sided p value <0.05 was considered significant.

RESULTS

Of the 9,619 SBO included in the analysis, 14.9 % adhesiolysis procedures were performed laparoscopically. Patients undergoing laparoscopic procedures had shorter mean operative times (77.2 vs. 94.2 min, p < 0.0001) and decreased postoperative length of stay (4.7 vs. 9.9 days, p < 0.0001). After controlling for comorbidities and surgical factors, patients having laparoscopic adhesiolysis were less likely to develop major complications [odds ratio (OR) = 0.7, 95 % confidence interval (CI) 0.58-0.85, p < 0.0001] and incisional complications (OR = 0.22, 95 % CI 0.15-0.33, p < 0.0001). The 30-day mortality was 1.3 % in the laparoscopic group versus 4.7 % in the open group (OR = 0.55, 95 % CI 0.33-0.85, p = 0.024).

CONCLUSIONS

Laparoscopic adhesiolysis requires a specific skill set and may not be appropriate in all patients. Notwithstanding this, the laparoscopic approach demonstrates a benefit in 30-day morbidity and mortality even after controlling for preoperative patient characteristics. Given these findings in more than 9,000 patients and consistent rates of SBO requiring surgical intervention in the United States, increasing the use of laparoscopy could be a feasible way of to decrease costs and improving outcomes in this population.

Intestinal obstruction due to bezoars: a retrospective clinical study

PURPOSE

The purpose of this study was to compare the results of surgical procedures applied to rare intestinal obstruction cases due to bezoars and to identify effective factors for determining the type of surgical procedure to be applied.

METHODS

The records of 62 patients who had received gastrointestinal surgical treatment due to bezoars were assessed retrospectively. The preoperative characteristics, perioperative findings and postoperative results of cases that had and had not undergone an enterotomy were compared

RESULTS

The average patient age was 57.7 years (range, 26-84 years), and all patients had phytobezoars, except one. The most common location for bezoars was the jejunum (28 cases, 45.1 %). Sixteen cases (25.8 %) had multiple bezoars located in different parts of the gastrointestinal tract. While milking was applied to 26 cases (41.9 %) with small intestinal bezoars, an enterotomy was used to remove bezoars in 23 cases (37 %). More complications tended to be identified in patients who underwent an enterotomy; however, the difference was not significant (p = 0.553).

CONCLUSIONS

The frequency of previous abdominal surgery in patients suffering from an intestinal obstruction due to bezoars causes diagnostic conflict. The location of bezoars in the small intestine should also be considered when deciding the surgical procedure, as well as the physical properties of the bezoars. Our opinion is that conducting the milking procedure should not be insisted on, and that an enterotomy should be conducted when necessary.

Single-port laparoscopic adhesiolysis for torsion ileus

Single-incisional laparoscopic surgery (SILS) has emerged as an attempt to further enhance the cosmetic benefits and reduce the morbidity of minimally invasive surgery. We present an approach of SILS adhesiolysis to adhesive strangulated ileus. A 70-year-old female patient, who had undergone laparoscopic low anterior resection 6 years before, underwent SILS adhesiolysis to a midline surgical incision wound adhesion site. The surgery was performed with only a 2.5-cm left-side transrectus incision using the SILS port. Laparoscopy revealed intestinal torsion and congestion with adhesion of the ileum to the previous surgical incision wound. SILS adhesiolysis was successfully carried out. The patient was discharged 4 days after surgery. SILS adhesiolysis is a feasible and efficient procedure in certain cases.

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

BACKGROUND

In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases.

METHODS

Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011.

RESULTS

A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer).

CONCLUSIONS

Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.

Laparoscopic adhesiolysis: consensus conference guidelines

AIM

Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice.

METHODS

A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts.

RESULTS

Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection.

CONCLUSION

Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons.

Clinical outcomes of laparoscopic adhesiolysis for mechanical small bowel obstruction

INTRODUCTION

Laparoscopy for small bowel obstruction (SBO) has increasingly been performed for the advantages minimally invasive surgery provides. However, its benefit remains unclear.

METHODS

From January 2004 to July 2011, we enrolled 28 consecutive patients who underwent a laparoscopic operation for SBO, secondary to postoperative adhesions. We compared the results of SBO patients treated laparoscopically with those of 25 patients who underwent conventional open laparotomy in a retrospective matched-pair analysis.

RESULTS

Laparoscopic treatment was completed in 25 patients (89%), including 17 laparoscopic-assisted cases. The mean procedural time was 112 minutes in the laparoscopic group and 79 minutes in the open group (P < 0.05). Patients resumed oral intake after a mean of 3 days in the laparoscopic group compared with a mean of 6.5 days in the open group (P < 0.05). The length of hospital stay was 11 and 22 days (P < 0.05), respectively, in the laparoscopic and open groups. Postoperative complications occurred in two patients in the laparoscopy group and 14 patients in the open group (P < 0.05).

CONCLUSION

The laparoscopic approach was effective for the management of mechanical SBO in selected patients. Furthermore, minimally invasive laparoscopic adhesiolysis is also feasible and brings the benefit of cosmetic results.

Primary midgut volvulus in adults: report of two cases and review of the literature

INTRODUCTION

This is a report of two male patients (35 and 54 years old, respectively) admitted to our surgical department with signs of small-bowel obstruction.

CASE PRESENTATIONS

Diagnostic workup with plain abdominal radiographs and, more specifically, computed tomography suggested the possibility of bowel rotation. In order to exclude any possibility of associated intestinal ischemia, both patients underwent exploratory laparotomy, which revealed a midgut volvulus without any associated obvious cause or pathology.

DISCUSSION

Both patients had an eventful outcome. Epidemiologic characteristics, clinical presentation, diagnostic workup, surgical treatment, and morbidity-mortality rates of small-bowel volvulus have been reviewed and thoroughly discussed.

The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases

BACKGROUND

Adhesive small-bowel obstruction (SBO) contributes significantly to emergency surgical workload. Laparotomy remains the standard approach. Despite published reports with high success rates and low morbidity, acute SBO is still considered by many a relative contraindication to laparoscopy. Our aim was to review the available literature and define important outcomes such as feasibility, safety, iatrogenic bowel injury, and benefits to patients with acute SBO who are approached laparoscopically.

METHODS

A systematic literature search was carried out using the Medline database and the search terms "laparoscopy" or "laparoscopic approach" and "bowel obstruction." Only adult studies published in English between 1990 and 2010 were included. Studies were excluded if data specific to outcomes for laparoscopic management of acute SBO could not be extracted.

RESULTS

Twenty-nine studies were identified. A laparoscopic approach was attempted in 2,005 patients with acute SBO. Adhesions were the most common etiology (84.9%). Laparoscopy was completed in 1,284 cases (64%), 6.7% were lap-assisted, and 0.3% were converted to hernia repair. The overall conversion rate to midline laparotomy was 29% (580/2,005). Dense adhesions, bowel resection, unidentified pathology, and iatrogenic injury accounted for the majority of conversions. When the etiology of SBO was a single-band adhesion, the success rate was 73.4%. Morbidity was 14.8% (283/1,906) and mortality was 1.5% (29/1,951). The enterotomy rate was 6.6% (110/1,673). The majority were recognized and converted to laparotomy. Laparoscopy was associated with reduced morbidity and length of stay.

CONCLUSION

Laparoscopy is a feasible and effective treatment for acute SBO with acceptable morbidity. Further studies are required to determine its impact on recurrent SBO.

Laparoscopic resection of a small bowel lipoma with incidental intussusception

Small bowel lipomas, which can cause intussusception and gastrointestinal bleeding, can be managed with laparoscopic resection when diagnosed preoperatively.

Background:

Small bowel tumors are rare entities that often present with nonspecific symptoms. The diagnosis is more likely in patients with occult gastrointestinal bleeding of unknown origin or in adults with small bowel intussusception. Even with exhaustive diagnostic testing, small bowel tumors are often not diagnosed preoperatively. Because 60% to 70% of small bowel tumors are malignant, surgical excision is always recommended.

Methods:

We report the case of a 73-year-old man with occult gastrointestinal bleeding. A small bowel tumor was discovered only after video capsule endoscopy, computed tomography, and multiple endoscopies were performed.

Results:

The patient underwent laparoscopic exploration. An incidental intussusception made the tumor simple to identify. By extending the umbilical port, the tumor was easily removed. The final pathology demonstrated a submucosal lipoma.

Conclusions:

Small bowel lipomas can cause intussusception and gastrointestinal bleeding. When diagnosed preoperatively, laparoscopic resection is feasible.

Strategies for diagnosis and treatment of small bowel obstruction

Small bowel obstruction, which is caused by a variety of etiological factors and mainly manifests as abdominal pain, vomiting and distension, is one of the most common acute abdomens. A rapid and accurate diagnosis of small bowel obstruction is needed to give reasonable and effective treatment to avoid its rapid deterioration. In this paper we discuss the strategies for diagnosis and treatment of small bowel obstruction through comparing different imaging methods for diagnosis of small bowel obstruction and reviewing the current situation of diagnosis and treatment of the disease in terms of pharmacotherapy, gastrointestinal decompression, and surgical intervention.

Laparoscopic management of intestinal obstruction

Laparoscopic adhesiolysis is a valuable tool for the surgeon performing complex minimally invasive procedures. It can be used for the management of intestinal obstruction and chronic abdominal pain syndromes. It is also an essential skill when performing laparoscopic surgery on patients who had prior abdominal operations. The use of laparoscopy for patients with an intestinal obstruction was once considered an absolute contraindication. With the advancement in optics and increasing experience, more and more surgeons are turning to laparoscopy as a useful diagnostic and therapeutic tool in more complex situations.

Small bowel emergency surgery: literature's review

Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.

Analysis of the videolaparoscopy potentiality in the surgical treatment of the bowel obstruction

CONTEXT

Laparotomy is the gold standard treatment of patients with intestinal obstruction without response to clinical management. Nowadays, literature has been demonstrating the feasibility of videolaparoscopy in the treatment of intestinal obstruction.

OBJECTIVES

To report the clinical-epidemiological profile of patients with intestinal obstruction submitted to surgery and verify the presence of contraindications for laparoscopy.

METHODS

It was done a observational, descriptive and retrospective study including adults patients with intestinal obstruction submitted to surgery at Hospital de Clínicas de Porto Alegre, RS, Brazil, between January of 2004 and October of 2008.

RESULTS

It was included 135 patients in the study, with a total of 126 patients submitted to open surgery and 9 to laparoscopy. There was similar distribution between gender and the mean age was 59 years (SD +/- 16.9). The most frequent site of obstruction was the small bowel and the most frequent etiology was adhesions. Among the patients submitted to laparotomy, 75.4% presented with abdominal distention, 68.3% previous abdominal surgery, 11.9% body mass index >30 kg/m(2), 4.8% coagulopathy and 3.2% hemodynamic instability. Among the 135 patients, only 5 of them presented with none contraindications for videolaparoscopy.

CONCLUSION

The epidemiological findings of this study are similar to the ones of the worldwide literature. Indications of videolaparoscopy in retrospective analyses have the limitation of subjective evaluation of intestinal obstruction, which was included in this study as a relative contraindication to laparoscopy.

Best resident poster award: evaluation of anastomotic techniques for laparoscopic resection of isolated small intestine pathology

BACKGROUND

The purpose of this study was to compare perioperative outcomes for intracorporeal versus extracorporeal anastomotic techniques for isolated laparoscopic small-intestine resection.

METHODS

A retrospective database was created for all adult patients who underwent a laparoscopic segmental small-intestine resection. Patients with inflammatory bowel disease or requiring an ileocolectomy were excluded.

RESULTS

Laparoscopic resection was performed in 52 patients (ratio of men:women, 30:22) with a mean age of 47 ± 21 years. A laparoscopic intracorporeal anastomosis was performed in 30 patients (58%), and an extracorporeal anastomosis was performed in 22 patients (42%). There was no difference in mean operating room time, estimated blood loss, perioperative complication rate, or length of stay between the 2 groups. Ten patients had a complication, and 5 patients experienced a Clavien grade II or greater complication.

CONCLUSIONS

Laparoscopic segmental small-bowel resection using either intracorporeal or extracorporeal anastomotic techniques is equally efficacious for pathology isolated to the small bowel.

Prolapse of Intussusception through the Anus as a Result of Sigmoid Colon Cancer

Adult intussusception is rare and most often associated with cancer. We report a case of intussuscepted sigmoid colon into the rectum protruding from the anus of a 47-year-old woman. The cause of the intussusception was sigmoid colon cancer. We removed the intussuscepted part of the sigmoid colon as well as the rectum and regional lymph nodes. The patient recovered uneventfully and there has been no evidence of recurrence of the cancer.