Laparoscopy for acute small-bowel obstruction secondary to adhesions

Background and Purpose: Postoperative adhesions are the leading cause of sm all-bowel obstruction in developed countries. Several arguments suggest tha t laparoscopy may lead to fewer adhesions than does laparotomy, We report h ere the short-term results of laparoscopy in patients admitted on an emerge ncy basis for acute small-bowel obstruction secondary to adhesions, Patients and Methods: This prospective trial included 134 consecutive patie nts: 39 underwent emergency surgery, and 95 had laparoscopic adhesiolysis s hortly after resolution of the obstruction with nasogastric suction. Of the previous operations for which the dates were known, 16% had taken place wi thin 1 year of the obstruction and 33.5% within 5 years. In all, 27% of the patients had open laparoscopy, and 16% had conversions: 7% after elective laparoscopy and 36% after emergency laparoscopy. Results: There were no operative deaths. One patient underwent a reoperatio n the following day for fistula after incomplete adhesiolysis attributable to multiple adhesions found during elective laparoscopy. If laparoscopy is considered to have failed when adhesiolysis was incomplete or conversion or reoperation was necessary, our success rate was 80% after elective laparos copy and 59% after emergency laparoscopy. Conclusion: Emergency situations in acute small-bowel obstruction combine s everal circumstances unfavorable for laparoscopy: a limited work area and a distended and fragile small bowel. Lap-aroscopic adhesiolysis after the cr isis has passed may produce better results, but only long-term follow-up ca n confirm the role of elective laparoscopy for this indication.