Jj. Duron et al., Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery - A retrospective multicenter study, ARCH SURG, 135(2), 2000, pp. 208-212
Hypothesis;: The prevalence and mechanisms of intestinal obstruction follow
ing laparoscopic abdominal surgery have not been studied extensively.
Design: Retrospective review of cases of intestinal obstruction after lapar
oscopic surgery.
Setting: Sixteen surgical units performing laparoscopy in France. Patients:
Twenty-four patients with intestinal obstruction.
Main Outcome Measures: Prevalence values and descriptive data.
Results: The 3 most frequent primary procedures responsible for intestinal
obstruction were cholecystectomy (10 cases), transperitoneal hernia repair
(5 cases), and appendectomy (4 cases). Prevalences of early postoperative i
ntestinal obstruction after these procedures were 0.11%, 2.5%, and 0.16%, r
espectively. intestinal obstruction was due to adhesions or fibrotic bands
in 12 cases and to intestinal incarceration in 11 cases. Obstruction was lo
cated at the trocar site in 13 cases (9 incarcerations and 4 adhesions), ma
inly at the umbilicus, and in the operative field in 10 cases(2 incarcerati
ons in a wail defect after transperitoneal inguinal hernia repair, 4 adhesi
ons, and 4 fibrotic bands). The small intestine was involved in 23 of 24 ca
ses; the other was due to fecal volvulus following unrecognized intestinal
malrotation. Intestinal obstruction was treated by laparoscopic adhesiolysi
s in 6 patients and by laparotomy in 18 patients, 6 of whom required small
intestine resection. Three postoperative complications but no deaths occurr
ed.
Conclusion: Intestinal obstruction following laparoscopic abdominal surgery
can occur irrespective of the type of operation: the prevalence is as high
as (cholecystectomy and appendectomy) or even higher than (transperitoneal
hernia repair) that seen in open procedures.