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Elkomos BE, Fahmy K, Kamel KA. Laparoscopic adhesiolysis versus open adhesiolysis in acute adhesive small bowel obstruction. J Minim Access Surg 2023; 19:511-517. [PMID: 37357493 PMCID: PMC10695316 DOI: 10.4103/jmas.jmas_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/11/2023] [Accepted: 04/07/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction Exploratory laparotomy is still the standard therapy for patients who need surgical intervention for adhesive small bowel obstruction (SBO). However, the use of laparoscopy in the management of adhesive SBO is still controversial. We aimed to detect the short-term outcomes between open and laparoscopic adhesiolysis for SBO. Patients and Methods This is a retrospective study of patients with adhesive SBO who underwent either laparoscopic or open surgery from June 2019 to July 2022 at Ain Shams University Hospitals. Intraoperative and early post-operative outcomes were compared in the two groups. Results A total of 89 patients with adhesive SBO were included in our study. Fifty-one cases underwent open adhesiolysis and 38 cases underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is associated with a remarkable decrease in the operative time (71 min vs. 107 min, P = 0.001) and blood loss (50 ml vs. 120 ml, P = 0.001) in comparison to open adhesiolysis. In addition to that, those who underwent adhesiolysis by laparoscopy had a short hospital stay (2.4 days vs. 3.8 days, P = 0.001), early recovery (time to pass flatus 1.3 days vs. 2.8 days) and less post-operative complications (surgical site infection [SSI] 2.6% vs. 19.6%, P = 0.001). Moreover, open adhesiolysis is associated with a higher rate of early post-operative mortality. In addition to that, the incidence of iatrogenic injury was higher in the open group. Conclusion Laparoscopic adhesiolysis is a safe and feasible approach for the management of SBO and has better short-term outcomes, especially if done by skilled surgeons in advanced laparoscopic techniques.
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Affiliation(s)
| | - Karim Fahmy
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
| | - Kareem Ahmed Kamel
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
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Demessence R, Lyoubi Y, Feuerstoss F, Hamy A, Aubé C, Paisant A, Venara A. Surgical management of adhesive small bowel obstruction: Is it still mandatory to wait? - An update. J Visc Surg 2022; 159:309-319. [PMID: 35272958 DOI: 10.1016/j.jviscsurg.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Small bowel obstruction syndromes (SBO) represent one of the main causes of emergency admission for surgical abdominal pain. The 2018 Bologna Guidelines (Ten Broek et al. 2018) recommend non-operative management at the outset if there are no signs of severity; surgery is proposed after 72h for the 20-30% of patients who fail medical management. However, these recommendations were based on old studies published at a time when laparoscopic surgery was not commonplace and when diagnostic capabilities (particularly for establishing etiology) were less developed than they are today. Additionally, the advent and development of laparoscopy and enhanced rehabilitation after surgery have led to a decrease in surgical morbidity. These guidelines are therefore now debated and several recent publications have encouraged urgent or semi-urgent surgical management for patients presenting for SBO in order to reduce morbidity, mortality, duration of hospitalization and costs, and to improve the feasibility of therapeutic laparoscopy. Prompt surgical management could also reduce the risk of recurrent small bowel obstructions. This model for early surgical management probably cannot be applied to all patients. It therefore seems important to select those patients at risk for failure of medical treatment and to identify those in whom the probability of successful laparoscopy is high. New radiological tools should allow better selection in the future. At the present time, the indications for early surgery "within 24h" should be emphasized.
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Affiliation(s)
- R Demessence
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - Y Lyoubi
- Faculty of Health of Angers, Department of Medicine, Angers, France; Urology Department, CHU d'Angers, 49933 Angers Cedex 9, France
| | - F Feuerstoss
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France
| | - A Hamy
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - C Aubé
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Paisant
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Venara
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France.
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Detz DJ, Podrat JL, Muniz Castro JC, Lee YK, Zheng F, Purnell S, Pei KY. Small bowel obstruction. Curr Probl Surg 2020; 58:100893. [PMID: 34130796 DOI: 10.1016/j.cpsurg.2020.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Yoon K Lee
- Houston Methodist Hospital, Houston, Texas
| | - Feibi Zheng
- Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas
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