LAPAROSCOPIC MANAGEMENT OF ACUTE SMALL-BO WEL OBSTRUCTION

Objectives. - The aim of this study was to evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute small bowel obs truction. Methods. - Thirty five patients, with less than three abdomi nal incisions, who had undergone initial laparoscopy for acute small b owel obstruction, were reviewed. The small bowel was mobilized to dete rmine the cause and site of obstruction. Results. - In 31 cases, small bowel obstruction was caused by a single or numerous obstructing band s. Among 31 cases of adhesions, laparoscopic treatment of intestinal o bstruction was possible in 16 cases (51.6 %). In 15 cases, laparoscopy had to be completed by laparotomy : numerous adhesions could not be d ivided in 12 cases; intestinal ischemia which required resection was p resent in 3 cases. There was no hospital mortality and postoperative c omplications occurred in 19 % of cases. Multivariate analysis demonstr ated a relation between need to complete laparoscopy by laparotomy and two factors : presence of signs of peritoneal irritation (P < 0.05) a nd intestinal obstruction caused by numerous adhesions or bands (P < 0 .05). Mean hospital stay and postoperative ileus were significantly sh orter in the ''laparoscopy'' group than in the ''laparoscopy + laparot omy'' group. Conclusions. - Laparoscopic treatement of acute small bow el obstruction is difficult and was possible in only half of the cases . The first port should be inserted by open technique to avoid the ris k of perforation of distented small bowel. When laparoscopy shows nume rous adhesions, laparoscopic treatment should not be pursued, and lapa rotomy should be recommended to avoid the risk of visceral perforation .