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Huang Y, Fu R, Liu D, Wen K. Keys to successful laparoscopic adhesiolysis for adhesive small bowel obstruction: A scoping review. Heliyon 2024; 10:e34359. [PMID: 39149046 PMCID: PMC11324824 DOI: 10.1016/j.heliyon.2024.e34359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024] Open
Abstract
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.
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Affiliation(s)
- Yuanqi Huang
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Ruimin Fu
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Dandan Liu
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Kunming Wen
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
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van den Beukel BAW, Toneman MK, van Veelen F, van Oud-Alblas MB, van Dongen K, Stommel MWJ, van Goor H, ten Broek RPG. Elective adhesiolysis for chronic abdominal pain reduces long-term risk of adhesive small bowel obstruction. World J Emerg Surg 2023; 18:8. [PMID: 36691000 PMCID: PMC9872389 DOI: 10.1186/s13017-023-00477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Selected patients with adhesion-related chronic abdominal pain can be treated effectively by adhesiolysis with the application of adhesion barriers. These patients might also have an increased risk to develop adhesive small bowel obstruction (ASBO). It is unknown how frequently these patients develop ASBO, and how elective adhesiolysis for pain impacts the risk of ASBO. METHODS Patients with adhesion-related chronic pain were included in this cohort study with long-term follow-up. The diagnosis of adhesions was confirmed using CineMRI. The decision for operative treatment of adhesions was made by shared agreement based on the correlation of complaints with CineMRI findings. The primary outcome was the 5-years incidence of readmission for ASBO. Incidence was compared between patients with elective adhesiolysis and those treated non-operatively and between patients with and without previous ASBO. Univariable and multivariable Cox regression analysis was performed to identify predictive factors for ASBO. Secondary outcomes included reoperation for ASBO and self-reported pain and other abdominal symptoms. RESULTS A total of 122 patients were included, 69 patients underwent elective adhesiolysis. Thirty patients in both groups had previous episodes of ASBO in history. During 5-year follow-up, the readmission rate for ASBO was 6.5% after elective adhesiolysis compared to 26.9% after non-operative treatment (p = 0.012). These percentages were 13.3% compared to 40% in the subgroup of patients with previous episodes of ASBO (p = 0.039). In multivariable analysis, elective adhesiolysis was associated with a decreased risk of readmission for ASBO with an odds ratio of 0.21 (95% CI 0.07-0.65), the risk was increased in patients with previous episodes with a odds ratio of 19.2 (95% CI 2.5-144.4). There was no difference between the groups in the prevalence of self-reported abdominal pain. However, in surgically treated patients the impact of pain on daily activities was lower, and the incidence of other symptoms was lower. CONCLUSION More than one in four patients with chronic adhesion-related pain develop episodes of ASBO when treated non-operatively. Elective adhesiolysis reduces the incidence of ASBO in patients with chronic adhesion-related symptoms, both in patients with and without previous episodes of ASBO in history. Trial registration The study was registered at Clinicaltrials.gov under NCT01236625.
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Affiliation(s)
- Barend A. W. van den Beukel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Masja K. Toneman
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Fleur van Veelen
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Koen van Dongen
- Department of Surgery, Pantein Hospital Boxmeer, Beugen, The Netherlands
| | - Martijn W. J. Stommel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Richard P. G. ten Broek
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Olivas-Alanis LH, Calzada-Briseño RA, Segura-Ibarra V, Vázquez EV, Diaz-Elizondo JA, Flores-Villalba E, Rodriguez CA. LAPKaans: Tool-Motion Tracking and Gripping Force-Sensing Modular Smart Laparoscopic Training System. SENSORS 2020; 20:s20236937. [PMID: 33291631 PMCID: PMC7730101 DOI: 10.3390/s20236937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/22/2023]
Abstract
Laparoscopic surgery demands highly skilled surgeons. Traditionally, a surgeon's knowledge is acquired by operating under a mentor-trainee method. In recent years, laparoscopic simulators have gained ground as tools in skill acquisition. Despite the wide range of laparoscopic simulators available, few provide objective feedback to the trainee. Those systems with quantitative feedback tend to be high-end solutions with limited availability due to cost. A modular smart trainer was developed, combining tool-tracking and force-using employing commercially available sensors. Additionally, a force training system based on polydimethylsiloxane (PDMS) phantoms for sample stiffness differentiation is presented. This prototype was tested with 39 subjects, between novices (13), intermediates (13), and experts (13), evaluating execution differences among groups in training exercises. The estimated cost is USD $200 (components only), not including laparoscopic instruments. The motion system was tested for noise reduction and position validation with a mean error of 0.94 mm. Grasping force approximation showed a correlation of 0.9975. Furthermore, differences in phantoms stiffness effectively reflected user manipulation. Subject groups showed significant differences in execution time, accumulated distance, and mean and maximum applied grasping force. Accurate information was obtained regarding motion and force. The developed force-sensing tool can easily be transferred to a clinical setting. Further work will consist on a validation of the simulator on a wider range of tasks and a larger sample of volunteers.
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Affiliation(s)
- Luis H. Olivas-Alanis
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
| | - Ricardo A. Calzada-Briseño
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
| | - Victor Segura-Ibarra
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León 64710, Mexico;
| | - Elisa V. Vázquez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
| | - Jose A. Diaz-Elizondo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León 64710, Mexico;
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
- Correspondence: (E.F.-V.); (C.A.R.)
| | - Ciro A. Rodriguez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
- Correspondence: (E.F.-V.); (C.A.R.)
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Safety and Indications of Laparoscopic Surgery for Postoperative Small-bowel Obstruction: A Single-center Study of 121 Patients. Surg Laparosc Endosc Percutan Tech 2018; 27:301-305. [PMID: 28614173 DOI: 10.1097/sle.0000000000000430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Barrie J, Russell L, Hood AJ, Jayne DG, Neville A, Culmer PR. An in vivo analysis of safe laparoscopic grasping thresholds for colorectal surgery. Surg Endosc 2018; 32:4244-4250. [PMID: 29602989 PMCID: PMC6132882 DOI: 10.1007/s00464-018-6172-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/21/2018] [Indexed: 11/29/2022]
Abstract
Background Analysis of safe laparoscopic grasping thresholds for the colon has not been performed. This study aimed to analyse tissue damage thresholds when the colon is grasped laparoscopically, correlating histological changes to mechanical compressive forces. Methods An instrumented laparoscopic grasper was used to measure the forces applied to porcine colon, with data captured and plotted as a force–time (f–t) curve. Haematoxylin and eosin histochemistry of tissue subjected to 10, 20, 40, 50 and 70 N for 5, 30 and 60 s was performed, and the area of colonic circular and longitudinal muscle was compared in grasped and un-grasped regions. The area under the f–t curve was calculated as a measure of the accumulated force applied, known as the force–time product (FTP). Results FTP ranged from 55.7 to 3793 N.s. Significant differences were observed between the muscle area of the grasped and un-grasped regions in both longitudinal and circular muscle at 50 N and above for all grasping times. For the longitudinal muscle, significant differences were observed between grasped and un-grasped areas at 20 N force for 30 s (mean difference = 59 mm2, 95% CI 41–77 mm2, P = 0.04), 20 N force for 60 s (mean difference = 31 mm2, 95% CI 21.5–40.5 mm2, P = 0.006) and 40 N force for 30 s (mean difference 37 mm2, 95% CI 27–47 mm2, P = 0.006). Changes in histology correlated with mechanical forces applied to the longitudinal muscle at a FTP over 300 N s. Conclusions This study characterizes the grasping forces that result in histological changes to the colon and correlates these with a mechanical measurement of the applied force. The findings will contribute to the development of smart laparoscopic graspers with active constraints to prevent excessive grasping and tissue injury.
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Affiliation(s)
- Jenifer Barrie
- School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK.
| | - Louise Russell
- School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
| | - Adrian J Hood
- School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
| | - David G Jayne
- Division of Clinical Sciences, Leeds Institute of Molecular Medicine, The University of Leeds, Leeds, UK
| | - Anne Neville
- School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
| | - Peter R Culmer
- School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
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Yao S, Tanaka E, Matsui Y, Ikeda A, Murakami T, Okumoto T, Harada T. Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity score-matched analysis. Surg Endosc 2017; 31:5348-5355. [DOI: 10.1007/s00464-017-5615-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/16/2017] [Indexed: 12/22/2022]
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Bove GM, Chapelle SL, Hanlon KE, Diamond MP, Mokler DJ. Attenuation of postoperative adhesions using a modeled manual therapy. PLoS One 2017; 12:e0178407. [PMID: 28574997 PMCID: PMC5456066 DOI: 10.1371/journal.pone.0178407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/13/2017] [Indexed: 12/11/2022] Open
Abstract
Postoperative adhesions are pathological attachments that develop between abdominopelvic structures following surgery. Considered unavoidable and ubiquitous, postoperative adhesions lead to bowel obstructions, infertility, pain, and reoperations. As such, they represent a substantial health care challenge. Despite over a century of research, no preventive treatment exists. We hypothesized that postoperative adhesions develop from a lack of movement of the abdominopelvic organs in the immediate postoperative period while rendered immobile by surgery and opiates, and tested whether manual therapy would prevent their development. In a modified rat cecal abrasion model, rats were allocated to receive treatment with manual therapy or not, and their resulting adhesions were quantified. We also characterized macrophage phenotype. In separate experiments we tested the safety of the treatment on a strictureplasty model, and also the efficacy of the treatment following adhesiolysis. We show that the treatment led to reduced frequency and size of cohesive adhesions, but not other types of adhesions, such as those involving intraperitoneal fatty structures. This effect was associated with a delay in the appearance of trophic macrophages. The treatment did not inhibit healing or induce undesirable complications following strictureplasty. Our results support that that maintained movements of damaged structures in the immediate postoperative period has potential to act as an effective preventive for attenuating cohesive postoperative adhesion development. Our findings lay the groundwork for further research, including mechanical and pharmacologic approaches to maintain movements during healing.
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Affiliation(s)
- Geoffrey M. Bove
- University of New England College of Osteopathic Medicine, Department of Biomedical Sciences, Stella Maris 102 Biddeford ME, United States of America
- * E-mail:
| | | | - Katherine E. Hanlon
- University of New England College of Osteopathic Medicine, Department of Biomedical Sciences, Stella Maris 102 Biddeford ME, United States of America
| | - Michael P. Diamond
- Medical College of Georgia, Augusta University, Department of Obstetrics and Gynecology, Augusta, GA United States of America
| | - David J. Mokler
- University of New England College of Osteopathic Medicine, Department of Biomedical Sciences, Stella Maris 102 Biddeford ME, United States of America
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Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg (Lond) 2017; 15:9-13. [PMID: 28203370 PMCID: PMC5295619 DOI: 10.1016/j.amsu.2017.01.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 12/13/2022] Open
Abstract
Formation of intra-abdominal adhesions is a common consequence of abdomino-pelvic surgery, radiation therapy, and inflammatory processes. In a small but clinically significant proportion of patients, adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent, or episodic. Due to the chronic and troublesome nature of these symptoms, adhesive disease may be life-altering in many patients, particularly when not recognized and appropriately addressed, as is the case not infrequently. In addition, there is a paucity of literature regarding the evaluation and management of patients with suspected abdominal adhesive disease. Therefore, in this concise review, we provide a clinically practical synopsis of the etiopathogenesis, symptoms, differential diagnosis, evaluation, and treatment of abdominal adhesive disease.
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Affiliation(s)
- N Tabibian
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - E Swehli
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - A Boyd
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - A Umbreen
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - J H Tabibian
- UC Davis Medical Center, Division of Gastroenterology and Hepatology, Sacramento, CA, USA
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Yang KH, Lee TB, Lee SH, Kim SH, Cho YH, Kim HY. Congenital adhesion band causing small bowel obstruction: What's the difference in various age groups, pediatric and adult patients? BMC Surg 2016; 16:79. [PMID: 27927245 PMCID: PMC5142405 DOI: 10.1186/s12893-016-0196-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/30/2016] [Indexed: 11/14/2022] Open
Abstract
Background A congenital adhesion band is a rare condition, but may induce a small bowel obstruction (SBO) at any age. However, only a few sporadic case reports exit. We aimed to identify the clinical characteristics of congenital adhesion band manifesting a SBO stratified by age group between pediatric and adult patients. Methods The medical records of all patients with a SBO between Jan 1, 2009 and Dec 31, 2015 were retrospectively reviewed. Cases associated with previous surgical procedure and cases of secondary obstruction due to inflammatory processes or tumor and other systemic diseases were excluded. The patients were divided into two groups according to age below or above 18 years: pediatric and adult. The basic clinical characteristics were analyzed and compared between groups. Results Of 251 patients with a SBO, 15 (5.9%) met the inclusion criteria; 10 cases in pediatric group (mean age 17.9 ± 38.7 months) and 5 cases in adult group (mean age 60.0 ± 19.7 years). The pediatric group (66.6%) included 3 neonates, 5 infants, and 2 school children. They usually presented with bilious vomiting (50.0%) and abdominal distention (60.0%), and demonstrated a high rate of early operation (80.0%) and bowel resection (70.0%). In contrast, the adult group (33.3%) presented with abdominal pain (100%) in all cases and underwent a relatively simple procedure of band release using a laparoscopic approach (60%). However, group differences did not reach statistical significance. In addition, two groups did not differ in the time interval to the operation or in the range of the operation (p = 0.089 vs. p = 0.329). No significant correlation was found between the time interval to the operation and the necessity of bowel resection (p = 0.136). There was no mortality in either group. Conclusions Congenital adhesion band is a very rare condition with diverse clinical presentations across ages. Unlike adult patients, pediatric patients showed a high proportion of early operation and bowel resection. A good result can be expected with an early diagnosis and prompt management regardless of age.
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Affiliation(s)
- Kwang-Ho Yang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae-Beom Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Si-Hak Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo-Hong Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. .,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. .,Department of Surgery, Pusan National University School of Medicine, Geumo-ro 20, Mulgeum-eup, 50612, Yangsan, Gyeongnam, Korea.
| | - Hae-Young Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Laparoscopic Surgery is Useful for Preventing Recurrence of Small Bowel Obstruction After Surgery for Postoperative Small Bowel Obstruction. Surg Laparosc Endosc Percutan Tech 2016; 26:e1-4. [PMID: 26771166 PMCID: PMC4736302 DOI: 10.1097/sle.0000000000000238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Nicolas G, Kfoury T, Shimlati R, Koury E, Tohmeh M, Gharios E, Wakim R. Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:712-719. [PMID: 27713389 PMCID: PMC5058432 DOI: 10.12659/ajcr.899664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. CASE REPORT All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention. CONCLUSIONS Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative.
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Affiliation(s)
- Gregory Nicolas
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Tony Kfoury
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Rasha Shimlati
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Elliott Koury
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Maroon Tohmeh
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Elie Gharios
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Raja Wakim
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
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Yao S, Tanaka E, Ikeda A, Murakami T, Okumoto T, Harada T. Outcomes of laparoscopic management of acute small bowel obstruction: a 7-year experience of 110 consecutive cases with various etiologies. Surg Today 2016; 47:432-439. [DOI: 10.1007/s00595-016-1389-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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13
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Hur JH, Oh B, Kim E, Ahn EJ, Park SH, Park JM. Laparoscopic Treatment of Intestinal Obstruction. JOURNAL OF ACUTE CARE SURGERY 2016. [DOI: 10.17479/jacs.2016.6.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jae Hun Hur
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Byeonghun Oh
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Eunyoung Kim
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Eun Jung Ahn
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Sei-Hyeog Park
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Jong-Min Park
- Department of Surgery, National Medical Center, Seoul, Korea
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Okamoto H, Maruyama S, Wakana H, Kawashima K, Fukasawa T, Fujii H. Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus. Medicine (Baltimore) 2016; 95:e2605. [PMID: 26825912 PMCID: PMC5291582 DOI: 10.1097/md.0000000000002605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Hirotaka Okamoto
- From the Department of Surgery, Tsuru Municipal Hospital, Tsuru, Tsuru-city, Japan (HO, SM, HW, KK, TF); and Gastrointestinal & Breast, Endocrine Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan (HF)
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15
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Jafari MD, Jafari F, Foe-Paker JE, Phelan MJ, Carmichael JC, Pigazzi A, Mills S, Stamos MJ. Adhesive Small Bowel Obstruction in the United States: Has Laparoscopy Made an Impact? Am Surg 2015. [DOI: 10.1177/000313481508101023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adhesions account for 74 per cent of admissions for small bowel obstruction (SBO). There is a lack of data regarding the usage and outcomes of laparoscopy (LS) for SBO. A retrospective review of urgent admissions for SBO using the Nationwide Inpatient Sample 2001 to 2011 was conducted. Among the estimated 3,948,987 SBO admissions, 36.7 per cent underwent operative management and LS was performed in 26.5 per cent with a 22.5 per cent conversion rate. Admissions increased by 3.1 per cent annually, whereas nonoperative management increased by 3.8 per cent annually. Operative management increased by 1.8 per cent annually, whereas LS increased by 8.9 per cent annually and open surgery decreased by 0.6 per cent annually. LS small bowel resection increased by a mean of 25 per cent annually. LS was associated with a 24.4 per cent in-hospital morbidity with intra-abdominal abscess/enteric fistulas (8.3%) and ileus (8.9%) as the most common complications. In-hospital mortality was 0.9 per cent with length of stay of 13 ± 9 days and a hospital charge of $80,080 ± 6,634. The majority of patients were operated on hospital day (HD) 1 (43.0%). Patients who underwent LS on HD >7 had a higher risk-adjusted mortality compared with earlier HD (odds ratio = 2.63; 95% confidence interval: 2.40–2.89; P < 0.01). There has been an increase in admissions for SBO and an increase in LS over the past 11 years. There seems to be an increase in mortality and morbidity with a later HD operation.
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Affiliation(s)
- Mehraneh D. Jafari
- Department of Surgery, University of California, Irvine, Orange, California
| | - Fariba Jafari
- Department of Surgery, University of California, Irvine, Orange, California
| | | | - Michael J. Phelan
- Department of Surgery, University of California, Irvine, Orange, California
| | | | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
| | - Steven Mills
- Department of Surgery, University of California, Irvine, Orange, California
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine, Orange, California
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16
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Choi SB, Han HJ, Kim WB, Song TJ, Choi SY. The Efficacy of Subcostal-Approach Laparoscopic Cholecystectomy in Patients with Previous Midline Incisions: Comparative Analysis with Conventional Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2014; 24:842-5. [DOI: 10.1089/lap.2014.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyung Joon Han
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Wan Bae Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sang Yong Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandalà V, Mandalà S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2013; 8:42. [PMID: 24112637 PMCID: PMC4124851 DOI: 10.1186/1749-7922-8-42] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 12/19/2022] Open
Abstract
Background In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery. Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin decrease incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery. Adhesions quantification and scoring maybe useful for achieving standardized assessment of adhesions severity and for further research in diagnosis and treatment of ASBO.
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Affiliation(s)
- Salomone Di Saverio
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | | | - Marica Galati
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Nazareno Smerieri
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Walter L Biffl
- Department of Surgery, Denver Health, University of Colorado Health Sciences Denver, Denver Health Medical Center, 777 Bannock Street, Denver CO 80204, USA
| | - Luca Ansaloni
- General Surgery I, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Gregorio Tugnoli
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - George C Velmahos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Cino Bendinelli
- Department of Surgery, John Hunter Hospital and University of Newcastle, Locke Bag 1 Hunter Region Maile Centre, Newcastle, NSW 2310, Australia
| | | | - Michael D Kelly
- Upper GI Unit, Department of Surgery, Frenchay Hospital, North Bristol, NHS Trust, Bristol, UK
| | - Frederick A Moore
- Department of Surgery, University of Florida, Gainesville, FL 32610-0254, USA
| | - Vincenzo Mandalà
- Department of General and Emergency Surgery, Associated Hospitals "Villa Sofia - Cervello", Palermo, Italy
| | - Stefano Mandalà
- Department of General and Emergency Surgery, Associated Hospitals "Villa Sofia - Cervello", Palermo, Italy
| | - Michele Masetti
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Elio Jovine
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Antonio D Pinna
- Emergency Surgery Unit, Department of General and Multivisceral Transplant Surgery, S Orsola Malpighi University Hospital, Bologna, Italy
| | - Andrew B Peitzman
- Division of General Surgery, University of Pittsburgh Physicians, Pittsburgh 15213 PA, USA
| | - Ari Leppaniemi
- Emergency Surgery, Department of Abdominal Surgery, Meilahti Hospital, University of Helsinki, Haartmaninkatu 4, 340, Helsinki FIN-00029 HUS, Finland
| | - Paul H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington, 20010 DC, USA
| | - Harry Van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101 6500 HB, Nijmegen, The Netherlands
| | - Ernest E Moore
- Department of Surgery, Denver Health, University of Colorado Health Sciences Denver, Denver Health Medical Center, 777 Bannock Street, Denver CO 80204, USA
| | - Johannes Jeekel
- Department of Surgery, Erasmus University Medical Center, PO Box 2040 3000 CA, Rotterdam, The Netherlands
| | - Fausto Catena
- Emergency Surgery Unit, Department of General and Multivisceral Transplant Surgery, S Orsola Malpighi University Hospital, Bologna, Italy.,Department of Emergency and Trauma Surgery, Maggiore Hospital of Parma, Parma, Italy
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Li MZ, Lian L, Xiao LB, Wu WH, He YL, Song XM. Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 2012; 204:779-86. [PMID: 22794708 DOI: 10.1016/j.amjsurg.2012.03.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 03/04/2012] [Accepted: 03/04/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to evaluate whether surgical outcomes differ between laparoscopy versus the open approach for adhesive small bowel obstruction. METHODS PubMed, MEDLINE, Embase, and the Cochrane Library databases were electronically searched from 1985 to 2010. The study pooled the effects of outcomes of a total of 334 patients enrolled into 4 retrospective comparative studies using meta-analytic methods. RESULTS Laparoscopic adhesiolysis was associated with a reduced overall complication rate (odds ratio = .42, .25-.70, P < .01), prolonged ileus rate (odds ratio = .28, .10-.73, P = .01) and pulmonary complication rate (odds ratio = .20, .04-.94, P = .04) compared with the open approach. No significant differences were noted for intraoperative injury to bowel rates (odds ratio = 1.93, .76-4.89, P = .17), wound infection rates (odds ratio = .44, .17-1.12, P = .08), and mortality (odds ratio = .81, .12-5.49, P = .83). CONCLUSIONS Laparoscopic adhesiolysis is advantageous in most of the analyzed outcomes. Laparoscopic treatment of small bowel obstruction is recommended by experienced laparoscopic surgeons in selected patients.
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Affiliation(s)
- Ming-Zhe Li
- Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China 510080
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19
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Okamoto H, Wakana H, Kawashima K, Fukasawa T, Fujii H. Clinical outcomes of laparoscopic adhesiolysis for mechanical small bowel obstruction. Asian J Endosc Surg 2012; 5:53-8. [PMID: 22776364 DOI: 10.1111/j.1758-5910.2011.00117.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 09/15/2011] [Accepted: 10/16/2011] [Indexed: 01/15/2023]
Abstract
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.
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Affiliation(s)
- H Okamoto
- Department of Surgery, Tsuru Municipal Hospital, Yamanashi, Japan.
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20
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O'Connor DB, Winter DC. The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc 2011; 26:12-7. [PMID: 21898013 DOI: 10.1007/s00464-011-1885-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 08/04/2011] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Donal B O'Connor
- Department of Surgery, Institute for Clinical Outcomes Research and Education, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.
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Park SY, Choi GS, Jun SH, Park JS, Kim HJ. Laparoscopic salvage surgery for recurrent and metachronous colorectal cancer: 15 years' experience in a single center. Surg Endosc 2011; 25:3551-8. [PMID: 21638182 DOI: 10.1007/s00464-011-1756-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 04/16/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic salvage surgery for colorectal cancer is a novel but technically challenging option for surgeons. The aim of this study was to evaluate the feasibility and safety of laparoscopic surgery in patients with recurrent or metachronous colorectal cancer in comparison with an open approach. METHODS The data used in this study were obtained from databases, the data of which were collected prospectively from January 1996 to February 2010. Data pertaining to patients, operations, and short-term outcomes were analyzed and compared between open and laparoscopic salvage groups. RESULTS Among the 3,425 patients studied, colorectal cancer recurred in 565 patients (16.5%) and 41 patients had colorectal salvage operations. Twenty-six patients with recurrence underwent open surgery and 15 cases underwent laparoscopic surgery. The short-term outcomes of the laparoscopic group were comparable with those of the open surgery group or were partly favorable. The five-year disease-free interval and overall survival of recurrent cancer patients were not significantly different from those of the open patients. Metachronous colorectal cancer occurred in 13 patients (0.38%), 5 of whom had open surgery and 6 had laparoscopic salvage. The only significant difference between the groups was a shorter operating time for the laparoscopic group. Late in the study, four patients in the laparoscopic recurrent group and one patient in the metachronous group were converted to open surgery. CONCLUSIONS Laparoscopic surgery yielded short-term outcomes that were comparable to those of conventional open surgery, in both recurrent and metachronous colorectal cancer patients. Thus, minimally invasive salvage approaches should be considered as a treatment option for the recurrent and the metachronous colorectal cancer patient.
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Affiliation(s)
- Soo Yeun Park
- Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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Abstract
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.
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Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2011; 6:5. [PMID: 21255429 PMCID: PMC3037327 DOI: 10.1186/1749-7922-6-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/21/2011] [Indexed: 12/11/2022] Open
Abstract
Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment. Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.
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Affiliation(s)
- Fausto Catena
- Emergency Surgery Unit, Department of General and Multivisceral Transplant Surgery, S, Orsola Malpighi University Hospital, Bologna, Italy.
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Roman H, Bourdel N, Canis M, Rigaud J, Delavierre D, Labat JJ, Sibert L. Adhérences et douleurs pelvipérinéales chroniques. Prog Urol 2010; 20:1003-9. [PMID: 21056378 DOI: 10.1016/j.purol.2010.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/16/2010] [Indexed: 11/26/2022]
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Tierris I, Mavrantonis C, Stratoulias C, Panousis G, Mpetsou A, Kalochristianakis N. Laparoscopy for acute small bowel obstruction: indication or contraindication? Surg Endosc 2010; 25:531-5. [DOI: 10.1007/s00464-010-1206-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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Abstract
The surgical indications for laparoscopic techniques continue to expand as experience is gained. This includes patients who have had a previous open abdominal operation and require surgical intervention. In addition to the generally accepted indications for laparoscopy, conditions such as reversal of colostomy, small bowel obstruction, and early reoperation for surgical complications may be managed using minimally invasive techniques. Specific considerations in this group of patients include peritoneal access and establishing domain, lysis of adhesions, and situations that should prompt conversion.
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Affiliation(s)
- Tracey D Arnell
- Department of Surgery, New York Presbyterian-Columbia Medical Center, New York, NY 10032, USA.
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27
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Abstract
The applicability of laparoscopy to many complex intraabdominal colorectal procedures continues to expand, and has been shown to be feasible and safe in experienced hands. Data are available on the elderly, rectal prolapse, diverticulitis, Hartman's takedown, small bowel obstruction, Crohn's disease, and ulcerative colitis. Clinically relevant advantages have been clearly demonstrated in selected patient populations. Laparoscopic surgery for benign colorectal disease should be considered in patients suitable for this approach to an abdominal operation.
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Affiliation(s)
- Y Panis
- Service de Chirurgie Digestive, Hôpital Lariboisière - Paris.
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28
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Kendrick ML. Partial small bowel obstruction: clinical issues and recent technical advances. ACTA ACUST UNITED AC 2009; 34:329-34. [PMID: 18597140 DOI: 10.1007/s00261-008-9436-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Mechanical small bowel obstruction (SBO) remains a common clinical problem despite ever-increasing medical and surgical advances. The predominant etiology continues to be postoperative adhesions, accounting for approximately two-thirds of all obstructive events. As opposed to high-grade or complete small bowel obstruction where the clinical and radiographic findings are typically more diagnostic and the treatment plan more defined, partial SBO represents a subgroup, where the evaluation is more arduous, the diagnosis more elusive, and the management less defined. Operative and nonoperative approaches to treatment are successful and are based on the etiology and clinical status of the patient. A paradox remains, however, treating a predominantly surgically induced condition with repeated operations. Several advances in the treatment and prevention of SBO have become practice in past decade. This article reviews the clinical issues and technical advances of this challenging condition.
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Affiliation(s)
- Michael L Kendrick
- Division of Gastroenterologic and General Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Grafen FC, Neuhaus V, Schöb O, Turina M. Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 2009; 395:57-63. [PMID: 19330347 DOI: 10.1007/s00423-009-0490-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/20/2009] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery. MATERIALS AND METHODS Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients). RESULTS Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique. CONCLUSIONS A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.
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Affiliation(s)
- Franziska Carmen Grafen
- Department of Surgery, Limmattal Hospital, Urdorferstr. 100, CH-8952, Schlieren, Zürich, Switzerland
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Nationwide Impact of Laparoscopic Lysis of Adhesions in the Management of Intestinal Obstruction in the US. J Am Coll Surg 2008; 207:520-6. [DOI: 10.1016/j.jamcollsurg.2008.04.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/19/2008] [Accepted: 04/16/2008] [Indexed: 11/23/2022]
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Cheung HYS, Siu WT, Yau KK, Chan JKW, Tang CN, Li MKW. Laparoscopic treatment for small bowel obstruction: report of a case. Surg Today 2008; 38:661-3. [PMID: 18612795 DOI: 10.1007/s00595-007-3713-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 05/18/2007] [Indexed: 11/30/2022]
Abstract
An unusual case of small bowel obstruction in a patient with "virgin abdomen" was successfully diagnosed and the localized pathology was elucidated by a computed tomography scan, and the case was successfully treated by laparoscopy.
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Affiliation(s)
- Hester Yui Shan Cheung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR, China
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Pearl JP, Marks JM, Hardacre JM, Ponsky JL, Delaney CP, Rosen MJ. Laparoscopic Treatment of Complex Small Bowel Obstruction: Is It Safe? Surg Innov 2008; 15:110-3. [DOI: 10.1177/1553350608319032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Laparoscopic treatment of small bowel obstruction has many reported advantages, yet it is infrequently performed. Criticisms include reduced working space, difficult abdominal access, and bowel injury. The experience with laparoscopic treatment of small bowel obstruction to determine its safety has been reviewed. Nineteen patients underwent laparoscopic treatment of small bowel obstruction. A cut-down technique was used for abdominal access and avoided manipulation of dilated bowel. The average number of prior operations was 1.4. The average size of maximally dilated bowel was 3.5 cm, including 6 patients whose diameter was greater than 4 cm. Laparoscopic treatment was successful in 16 patients; 3 patients required laparotomy. There were no complications from abdominal access and no iatrogenic bowel injuries. This series demonstrated that abdominal access and relief of bowel obstruction can be safely performed laparoscopically in patients with complex small bowel obstruction. Neither massively dilated bowel nor multiple previous abdominal operations precluded safe conduct of the operation laparoscopically.
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Affiliation(s)
- Jonathan P. Pearl
- Department of Surgery, National Naval Medical Center, Bethesda, Maryland,
| | - Jeffrey M. Marks
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey M. Hardacre
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey L. Ponsky
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Conor P. Delaney
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael J. Rosen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. The laparoscopic management of small-bowel obstruction. Am J Surg 2007; 194:882-7; discussion 887-8. [DOI: 10.1016/j.amjsurg.2007.08.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 01/26/2023]
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Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 2007; 21:1945-9. [PMID: 17879114 DOI: 10.1007/s00464-007-9575-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 06/29/2007] [Accepted: 08/29/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute small bowel obstruction has previously been considered a relative contraindication for laparoscopic management. As experience with laparoscopy grows, more surgeons are attempting laparoscopic management for this indication. The purpose of this study is to define the outcome of laparoscopy for acute small bowel obstruction through an analysis of published cases. METHODS A literature search of the Medline database was performed using the key words laparoscopy and bowel obstruction. Further articles were identified from the reference lists of retrieved literature. Only English language studies were reviewed. We excluded studies that included patients with chronic abdominal pain, chronic recurrent small bowel obstruction, or gastric or colonic obstruction, when the data specific to acute small bowel obstruction could not be extracted. Data was analyzed based on an intention to treat. RESULTS Nineteen studies from between 1994 and 2005 were identified. Laparoscopy was attempted in 1061 patients with acute small bowel obstruction. The most common etiologies of obstruction included adhesions (83.2%), abdominal wall hernia (3.1%), malignancy (2.9%), internal hernia (1.9%), and bezoars (0.8%). Laparoscopic treatment was possible in 705 cases with a conversion rate to open surgery of 33.5%. Causes of conversion were dense adhesions (27.7%), the need for bowel resection (23.1%), unidentified etiology (13.0%), iatrogenic injury (10.2%), malignancy (7.4%), inadequate visualization (4.2%), hernia (3.2%), and other causes (11.1%). Morbidity was 15.5% (152/981) and mortality was 1.5% (16/1046). There were 45 reported recognized intraoperative enterotomies (6.5%), but less than half resulted in conversion. There were, however, nine missed perforations, including one trocar injury, often resulting in significant morbidity. Early recurrence (defined as recurrence within 30 days of surgery) occurred in 2.1% (22/1046). CONCLUSION Laparoscopy is an effective procedure for the treatment of acute small bowel obstruction with acceptable risk of morbidity and early recurrence.
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Affiliation(s)
- Bashar Ghosheh
- Department of Surgery, University of Mississippi, Jackson, MS, USA
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Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. Laparoscopic Management of Adhesive Small Bowel Obstruction. Am Surg 2007. [DOI: 10.1177/000313480707300808] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adhesions from prior surgery are the most common cause of small bowel obstruction (SBO) in the Western world. Although laparoscopic adhesiolysis can be performed safely and effectively, the indications and contraindications to the use of laparoscopic techniques in SBO are not clearly defined. The goal of our study was to determine the outcomes of the laparoscopic approach to SBO and discuss patient considerations for its utilization. We retrospectively surveyed all patients undergoing laparoscopic or attempted laparoscopic adhesiolysis performed by the authors between July 1997 and March 2006. Data obtained included patient demographics, clinical and radiologic presentation, and intraoperative and postoperative course. Thirty-three patients underwent laparoscopic adhesiolysis secondary to a SBO. Mean age was 53.6 years (range, 29–84 years) and 64 per cent (21 of 33) were female. Mean body mass index was 30.0 kg/m2 (range, 22.6–46.1 kg/m2). Thirty-one patients (93.9%) had undergone between one and four abdominal surgeries and seven (21.2%) had a previous episode of SBO. There were no patients with peritonitis. Abdominal CT scan was performed preoperatively in 27 patients (81.8%). Laparoscopy diagnosed the site of obstruction in all patients. Twenty-nine patients (88%) were successfully treated laparoscopically. Conversion to laparotomy was required in four cases as a result of dense adhesions and/or a lack of working space. Mean procedural time was 101 minutes (range, 19–198 minutes). There was one intraoperative complication (enterotomy), which was repaired laparoscopically and did not require conversion. Conversion was associated with significantly increased procedural time (129 versus 93 minutes; P = 0.02), but not blood loss or complications. Average times to passage of flatus and first bowel movement were 2.3 days (range, 0.5–5 days) and 3.2 days (range, 1–6 days), respectively. Seven patients (21.2%) had postoperative complications, including wound infection, urinary tract infection, and acute renal insufficiency, all of which occurred in patients completed laparoscopically. One patient had a recurrent SBO 8 months postoperatively managed by repeat laparoscopic lysis of adhesions. Mean postoperative stay was 6 days (range, 1–19 days). There was no hospital mortality. Laparoscopy is safe and feasible in the management of acute SBO in selected patients. It is an excellent diagnostic tool and is therapeutic in most cases.
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Affiliation(s)
- Marc Zerey
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina; and
| | - Catherine W. Sechrist
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina; and
| | - Kent W. Kercher
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina; and
| | - Ronald F. Sing
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina; and
| | | | - B. Todd Heniford
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina; and
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Seid VE, Imperiale AR, Araújo SE, Campos FGCMD, Sousa Jr AHDSE, Kiss DR, Cecconello I. A videolaparoscopia no diagnóstico e tratamento da obstrução intestinal. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-98802007000200018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A obstrução intestinal constitui complicação freqüente, de etiologia multifatorial, apresentação clínica variável e alta morbidade. Uma vez esgotados os recursos conservadores em casos específicos, a laparotomia exploradora é empregada para o diagnóstico final e tratamento em grande número de pacientes. Apesar do sucesso da via laparoscópica no manuseio de diversas afecções, a utilização desta via na abordagem inicial da obstrução do intestino delgado tem sido bastante limitada e alvo de numerosas críticas. Entretanto, o acúmulo de experiência com o método nos últimos anos, aliado ao avanço tecnológico e instrumental, têm permitido tratar número cada vez maior de pacientes obstruídos por meio do acesso laparoscópico. Assim, o surgimento de novos instrumentos como grampeadores laparoscópicos, pinças e trocáteres menos traumáticos ajudaram a tornar a videolaparoscopia factível e segura nestes pacientes. Neste artigo, os autores apresentam uma revisão sobre o papel da vídeo-cirurgia em casos selecionados de obstrução intestinal, ressaltando a contribuição dos métodos minimamente invasivos para o arsenal diagnóstico e terapêutico desta importante complicação.
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Chowbey PK, Panse R, Sharma A, Khullar R, Soni V, Baijal M. Elective laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. Surg Laparosc Endosc Percutan Tech 2007; 16:416-22. [PMID: 17277659 DOI: 10.1097/01.sle.0000213746.92901.b4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. METHODS Retrospective analysis of 253 patients who underwent therapeutic laparoscopy for recurrent small bowel obstruction from June 1996 to May 2005 was carried out. Patients with acute small bowel obstruction, bowel obstruction due to tumor, and obstructed inguinal hernias were excluded from analysis. RESULTS Laparoscopy diagnosed cause of obstruction in all except 3 (1.18%) patients. The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%). One hundred sixty nine patients were managed totally laparoscopically with adhesiolysis. Therapeutic bowel intervention other than adhesiolysis was required in 84 patients, of which 33 procedures were performed totally laparoscopically and remaining 51 procedures were completed with laparoscopically guided target incision. Five patients required conversion to open celiotomy. Iatrogenic enterotomies occurred in 3 patients and small bowel perforation during manipulation occurred in 1 patient. Postoperative procedure-related complications were seen in 44 patients. There was one mortality due to postoperative arrhythmia and cardiac failure. CONCLUSIONS Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases.
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Affiliation(s)
- Pradeep K Chowbey
- Minimal Access and Bariatric Surgery Center, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Abstract
BACKGROUND Intra-abdominal adhesions constitute between 49% and 74% of the causes of small bowel obstruction. Traditionally, laparotomy and open adhesiolysis have been the treatment for patients who have failed conservative measures or when clinical and physiologic derangements suggest toxemia and/or ischemia. With the increased popularity of laparoscopy, recent promising reports indicate the feasibility and potential superiority of the minimally invasive approach to the adhesion-encased abdomen. METHODS The purpose of this study was to assess the outcome of laparoscopic adhesiolysis and to provide technical tips that help in the success of this technique. RESULTS The most important predictive factor of adhesion formation is a history of previous abdominal surgery ranging from 67%-93% in the literature. Conversely, 31% of scars from previous surgery have been free of adhesions, whereas up to 10% of patients without any prior surgical scars will have spontaneous adhesions of the bowel or omentum. Most intestinal obstructions follow open lower abdominopelvic surgeries such as colectomy, appendectomy, and hysterectomy. The most common complications associated with adhesions are small bowel obstruction (SBO) and chronic pain syndrome. The treatment of uncomplicated SBO is generally conservative, especially with incomplete obstruction and the absence of systemic toxemia, ischemia, or strangulation. When conservative treatment fails, surgical options include conventional open or minimally invasive approaches; the latter have become increasing more popular for lysis of adhesions and the treatment of SBO. Generally, 63% of the length of a laparotomy incision is involved in adhesion formation to the abdominal wall. Furthermore, the incidence of ventral hernia after a laparotomy ranges between 11% and 20% versus the 0.02%-2.4% incidence of port site herniation. Additional benefits of the minimally invasive approaches include a decreased incidence of wound infection and postoperative pneumonia and a more rapid return of bowel function resulting in a shorter hospital stay. In long-term follow up, the success rate of laparoscopic lysis of adhesions remains between 46% and 87%. Operative times for laparoscopy range from 58 to 108 minutes; conversion rates range from 6.7% to 43%; and the incidence of intraoperative enterotomy ranges from 3% to 17.6%. The length of hospitalization is 4-6 days in most series. CONCLUSIONS Laparoscopic lysis of adhesions seems to be safe in the hands of well-trained laparoscopic surgeons. This technique should be mastered by the advanced laparoscopic surgeon not only for its usefulness in the pathologies discussed here but also for adhesions commonly encountered during other laparoscopic procedures.
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Affiliation(s)
- Samuel Szomstein
- Bariatric Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, Florida 33331, USA.
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Wu JM, Lin HF, Chen KH, Tseng LM, Huang SH. Laparoscopic Diagnosis and Treatment of Acute Small Bowel Obstruction Resulting From a Congenital Band. Surg Laparosc Endosc Percutan Tech 2005; 15:294-6. [PMID: 16215491 DOI: 10.1097/01.sle.0000183258.34926.59] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute small bowel obstruction is a common problem, especially for those patients with previous abdominal surgery that can cause postoperative adhesions. Acute, non-postoperative small bowel obstruction is less common and has various etiologies. We report a case of acute small bowel obstruction without previous abdominal surgery. The patient underwent laparoscopic exploration, and a congenital band was found to cause direct compression of the ileum and entrapment of a segment of bowel loop. There was evidence of bowel strangulation. The color and peristalsis of the entrapped bowel loop recovered gradually after division of the band, and segmental bowel resection was avoided. He has remained asymptomatic since the procedure. We suggest early and aggressive surgical intervention for patients with acute, non-postoperative small bowel obstruction to avoid possible complications of bowel strangulation and gangrene. A laparoscopic approach may be a safe, feasible, and favorable option for correct diagnosis and appropriate treatment in this situation.
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Affiliation(s)
- Jiann-Ming Wu
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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Al-Rashedy M, Issa ME, Ballester P, Ammori BJ. Laparoscopic surgery for the management of obstruction of the gastric outlet and small bowel following previous laparotomy for major upper gastrointestinal resection or cancer palliation: a new concept. J Laparoendosc Adv Surg Tech A 2005; 15:153-9. [PMID: 15898907 DOI: 10.1089/lap.2005.15.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical relief of gastric outlet obstruction (GOO) or small bowel obstruction in patients who had undergone major resection or palliative bypass surgery for malignancy is conventionally achieved at a laparotomy. The potential role of minimally invasive surgery in the management of these complications has not been previously explored. METHODS Between 2003 and 2004, 4 consecutive patients, age range 37 to 72 years, where admitted with gastric outlet or proximal small bowel obstruction following previous open surgery for suspected intra-abdominal malignancy, under the care of one surgeon. The respective past histories of these patients were recurrent GOO and concomitant distal biliary obstruction following a previous open gastric bypass elsewhere for metastatic pancreatic head cancer; persistent adhesive small bowel obstruction following radical gastrectomy for gastric cancer; GOO secondary to intra-abdominal recurrence 6 months after hepatobiliary resection for hilar cholangiocarcinoma; and GOO following previous pancreatico-duodenectomy for suspected pancreatic head cancer. Their respective surgical management consisted of a laparoscopic re-do gastric bypass and concomitant cholecystojejunostomy; adhesiolysis and revision of the Roux-en-Y enteric anastomosis; a Devine exclusion gastroenterostomy; and resection and refashioning of the gastroenterostomy. RESULTS There were no conversions to open surgery and no postoperative complications. The median operating time was 240 minutes (range, 145 to 300 minutes). Oral free fluid intake was resumed on postoperative day (POD) 1, while diet was resumed between POD 2 and 4. The median postoperative hospital stay was 15.5 days (range, 14 to 25 days). CONCLUSION Previous laparotomy and major resection or palliation of malignancy do not preclude the application of the laparoscopic approach for the management of upper gastrointestinal obstruction. Laparoscopic adhesiolysis and revision of enteroenteric and gastroenteric anastomoses are feasible management options in the hands of those experienced with complex laparoscopic surgery.
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Nauta RJ. Advanced abdominal imaging is not required to exclude strangulation if complete small bowel obstructions undergo prompt laparotomy. J Am Coll Surg 2005; 200:904-11. [PMID: 15922204 DOI: 10.1016/j.jamcollsurg.2004.12.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 12/15/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND When small bowel obstruction is demonstrated clinically or radiographically to be complete, operation is advocated because of the demonstrated association of strangulation obstruction with complete obstruction and the difficulty of diagnosing strangulation obstruction. Short observation periods, fluoroscopic procedures, and cross-sectional imaging are used in treatment of partial obstruction by those who believe that observation is futile or dangerous. This approach holds that few patients resolve after a day or two of observation; if this premise were true, protracted observation should see few patients resolve and some require resection for necrotic bowel after failed observation. Observer bias and the spectrum of nonnecrotic ischemia makes end-point analysis after laparotomy difficult to interpret; few criteria or incentives exist for a surgeon to speculate that a patient brought to surgery might have recovered without it. STUDY DESIGN I reviewed the clinical courses of 413 obstructed patients seen over 13 years. RESULTS Seventy-two patients underwent immediate treatment for complete obstruction, 294 resolved without operation, and 47 patients required operation after a period of observation ranging from 3 to 15 days. All observed patients were followed using clinical examination, leukocyte count, and plain film radiography only. No bowel resections were required in patients who were observed. CONCLUSIONS Research opportunities exist for use of alternatives to plain film imaging in treatment of partial small bowel obstruction, but this series does not support the premise that there is a risk for bowel ischemia or bowel resection by observing patients with partial small bowel obstruction or by following them with plain films alone. Indeed, such a strategy resulted in resolution in 294 of 341 patients so treated, with readmission and reoperation rates comparable with those reported in series in which earlier operation was undertaken.
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Affiliation(s)
- Russell J Nauta
- Department of Surgery, Georgetown University Medical Center, Washington, DC, USA
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Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic management of acute small bowel obstruction. Surg Endosc 2005; 19:464-7. [PMID: 15959710 DOI: 10.1007/s00464-004-9038-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 10/08/2004] [Indexed: 01/03/2023]
Abstract
BACKGROUND As minimally invasive surgery gains ground, it is entering realms previously considered to be relative contraindications for laparoscopy. We reviewed our experience with the laparoscopic approach to the management of small bowel obstruction (SBO). METHODS From December 1997 to November 2002, 65 patients underwent laparoscopic treatment for SBO. The operating surgeon attempted to identify a transitional point between distended and collapsed bowel and then address the obstruction at that point. RESULTS Postoperative adhesions were the cause of the obstruction in 44 patients. Tumor was identified in five cases, hernia in four, bezoar in three, intussusception in three, acute appendicitis and pseudoobstruction in two cases each, and terminal ileitis in one case. The diagnostic accuracy of laparoscopy was 96.9%. Thirty-four patients (52%) were treated by laparoscopy alone. Thirteen patients (20%) required a small target incision for segmental resection. Eighteen operations were converted to formal laparotomy. The mean laparoscopy time was 40 min (range, 25-160). Patients resumed oral intake in 1-3 days. The complication rate was 6.4%. There were two deaths, but none related to laparoscopy. The mean hospital stay was 4.2 days. CONCLUSIONS Laparoscopy is a useful minimally invasive technique for the management of acute SBO. It is an excellent diagnostic tool and, in most cases, a therapeutic surgical approach in patients with SBO. However, a significant number of patients will require conversion.
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Affiliation(s)
- B Kirshtein
- Department of Surgery A, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, 84101, Israel.
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Majewski WD. Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial. Surg Endosc 2004; 19:81-90. [PMID: 15529189 DOI: 10.1007/s00464-003-9333-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2004] [Accepted: 07/16/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to determine the long-term outcome of laparoscopic and open therapies for acute abdomen, and to assess the patients postoperative quality of life, with special attention to adhesions. METHODS A follow-up study was conducted from June through December 2001 of a case-control trial of laparoscopic and open surgical treatment in patients with acute abdomen. Mean (median) duration of follow-up was 35.9 months (32.5) for the laparoscopic group (L) and 40.7 months (38.5) for the open group (O). A total of 284 (92%) of the original 310 study patients (108 L and 202 O) were contacted. Twenty-eight (9%) were confirmed to be dead. From the remaining 256 patients (131 men and 125 women, mean age [+/- SD] 38.9 +/- 19.9 years), we enrolled 153(67 L and 91 O) in the follow-up. The main outcome measures were frequency of relapse requiring treatment, frequency of reoperations, incidence of adhesion ileus and incisional hernia, distant morbidity and mortality, satisfaction with therapy, and Gastrointestinal Quality of Life Index (GQLI) scores. RESULTS The morbidity and mortality rates, readmission rates, incisional hernia rates, and scores for long-term quality of life were the same in both groups. The reoperation rate was significantly higher among L patients, but there were significantly fewer episodes of adhesion ileus in this group. Patient satisfaction was 85% in the L group and 73% in the O group (p = NS). CONCLUSIONS The laparoscopic treatment of patients with acute abdomen offers an outcome comparable to that achieved with the open approach. There were fewer episodes of adhesion ileus in laparoscopic patients. Consequently, the operative treatment of acute abdomen patients by laparoscopy can be recommended.
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Affiliation(s)
- W D Majewski
- Department of General and Transplantation Surgery and Faculty of Nursing, Pomeranian Medical University, Szczecin, Poland.
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Nagle A, Ujiki M, Denham W, Murayama K. Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 2004; 187:464-70. [PMID: 15041492 DOI: 10.1016/j.amjsurg.2003.12.036] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Revised: 08/11/2003] [Indexed: 01/30/2023]
Abstract
BACKGROUND Historically, laparotomy and open adhesiolysis have been the treatment for patients requiring surgery for small bowel obstruction. Laparoscopic adhesiolysis has not gained wide acceptance. The indications and outcomes of laparoscopic adhesiolysis for small bowel obstruction are not well established. The purpose of this paper is to review the literature on laparoscopic adhesiolysis for small bowel obstruction and to discuss patient selection, surgical technique, and outcomes. DATA SOURCES Medline search from 1980 to 2002. CONCLUSIONS Laparoscopic adhesiolysis has been shown to be safe and feasible in experienced hands. For selected patients, laparoscopic adhesiolysis offers the advantages of decreased length of stay, faster return to full activity, and decreased morbidity. Patient selection and surgical judgment appear to be the most important factors for a successful outcome.
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Affiliation(s)
- Alexander Nagle
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 201 E. Huron St., Galter 10-105, Chicago, IL 60611, USA
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Hoyuela C, Veloso E, Marco C. Abordaje laparoscópico de la oclusión mecánica de intestino delgado en pacientes seleccionados. Resultados preliminares. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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46
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Abstract
We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction.
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Affiliation(s)
- Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Japan.
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Pekmezci S, Altinli E, Saribeyoglu K, Carkman S, Hamzaoglu I, Paksoy M, Uras C, Korman U, Sirin F. Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstructions. Surg Laparosc Endosc Percutan Tech 2002; 12:165-70. [PMID: 12080256 DOI: 10.1097/00129689-200206000-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6-39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.
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Affiliation(s)
- Salih Pekmezci
- Department of General Surgery, Cerrahpasa Medical School, University of Istanbul, Turkey.
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