Laparoscopic approach in acute small bowel obstruction. A review of 68 patients

BACKGROUND/AIMS: Laparoscopic management of acute small bowel obstruction h as potential advantages over classical laparotomy. The aims of this study w ere to assess the feasibility and the safety of this technique, as well as to find any predictive success factors. METHODOLOGY: A laparoscopic approach was undertaken in 68 out of 150 patien ts admitted between 1991 and 1997 for acute small bowel obstruction. RESULTS: The cause of obstruction was bands or adhesions in 80% of the pati ents. A correct laparoscopic diagnosis was established in 66% of the cases. A laparoscopic treatment was performed successfully in 31 patients (46%), and was assisted by minilaparotomy in 4 patients (6%), and by open herniorr aphy in 2 patients (3%). Thirty-one patients (46%) needed a conversion to l aparotomy. There were 6 bowel injuries (9%), all recognized during laparosc opy. There were 2 deaths in converted patients and 2 early reoperations for persisting ileus in patients treated by laparoscopy alone or by assisted l aparoscopy. CONCLUSION: Acute small bowel obstruction can be treated by laparoscopy alo ne, or assisted by minilaparotomy or open herniorraphy with advantages for the patient and few complications despite a high rate of conversion. There were no pre-operative predictive factors for successful laparoscopy, except for an isolated previous scar from an appendectomy. Pre-operative predicti ve success factors were parietal intestinal adhesions, as the only cause of obstruction. Multiple adhesions will mostly require conversion to laparoto my.