Laparoscopic management of mechanical small bowel obstruction - Are there predictors of success or failure?

Background: Laparoscopy is used increasingly for the management of acute ab dominal conditions. For many years, previous abdominal surgery and intestin al obstruction have been regarded as contraindications to laparoscopy becau se there is an increased risk of iatrogenic bowel perforation. The role of laparoscopy in acute small bowel obstruction remains unclear. Methods: Since 1995, data from patients undergoing laparoscopic surgery hav e been entered prospectively into a database. Patients who underwent surger y before 1995 were added retrospectively to the same database. The charts o f all patients treated surgically for mechanical small bowel obstruction we re reviewed. Univariate analysis was performed to identify factors associat ed with success or failure, especially intraoperative complications, conver sion, and postoperative morbidity. Stepwise logistic regression was used to assess for independent variables. Results: This study included 83 patients (56 women and 27 men) with a mean age of 56 years (range, 17-91 years). Conversion was necessary in 36 cases (43%). Laparoscopy alone was successful in 47 patients (57%). Intraoperativ e complications were noted in 16% and postoperative complications in 31% of the patients. Eight reoperations (9%) were necessary. Mortality was 2.4%. Duration of surgery (p < 0.001) and a bowel diameter exceeding 4 cm (p = 0. 02) were predictors of conversion. No risk factor for intraoperative compli cation was identified. Accidental bowel perforation (p = 0.008) and the nee d for conversion (p = 0.009) were the only independent factors associated w ith an increased risk of postoperative complications. Conclusions: Laparoscopic management of small bowel obstruction is possible in roughly 60% of the patients selected for this approach. Morbidity is lo wer, resumption of a normal diet is faster, and hospital stay is shorter th an with patients requiring conversion. No clear predictor of success or fai lure was identified, but intraoperative complications must be avoided. If t he surgeon is widely experienced in advanced laparoscopic surgery and there is a liberal conversion policy, laparoscopy is a valuable alternative to c onventional surgery in the management of acute small bowel obstruction.