Surgical decisions in the laparoscopic management of small bowel obstruction: Report on two cases
General Surgery Service, United States Air Force (USAF) Hospital, Hill Air Force Base (AFB), Utah 84050, USA.Journal of laparoendoscopic surgery 05/1996; 6(2):117-2. DOI: 10.1089/lps.1996.6.117
Laparoscopic management of bowel obstruction secondary to adhesions presents a difficult challenge for the general surgeon. The surgical management of two such cases is reported here: one patient with recurrent abdominal pain secondary to partial bowel obstruction, the other with acute small bowel obstruction. Surgical decision-making and technical aspects of the procedures are described. With careful patient selection and meticulous technique laparoscopic resolution of bowel obstruction may be feasible and should be attempted.
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ABSTRACT: Acute small bowel obstruction (SBO) has been a relative contraindication for laparoscopic treatment due to the potential for bowel distention and the risk of enteric injury. However, as laparoscopic experience has increased, surgeons have begun to apply minimal access techniques to the management of acute SBO. A retrospective review was performed of all patients with acute SBO in whom laparoscopic treatment was attempted. Patients with chronic symptoms and elective admission were excluded. Patients treated by laparoscopy were compared to those converted to laparotomy for differences in morbidity, postoperative length of stay, and return of bowel function as evidenced by toleration of a liquid diet. Laparoscopy was performed in 40 patients for acute SBO. The etiologies of obstruction included adhesions (35 cases), Meckel's diverticulum (two cases), femoral hernia (one case), periappendiceal abscess (one case), and regional enteritis (one case). Laparoscopic treatment was possible in 24 patients (60%), but 13 patients required conversion to laparotomy for inadequate laparoscopic visualization (two cases), infarcted bowel (two cases), enterotomy (four cases), and inability to relieve the obstruction laparoscopically (five cases). There were ten complications-one in the laparoscopic group (pneumonia) and nine in the converted group (prolonged ileus, four cases; wound infection, two cases; pneumonia, two cases; and perioperative myocardial infarction, one case). Respectively, the laparoscopic and converted groups had mean operative times of 68 and 106 min a mean return of bowel function of 1.8 and 6.2 days, and a mean postoperative stay of 3.6 and 10.5 days. Long-term follow-up was available in 34 patients. One recurrence of SBO requiring operation occurred in each group during a mean follow-up of 88 weeks. Laparoscopy is a safe and effective procedure for the treatment of acute SBO in selected patients. This approach requires surgeons to have a low threshold for conversion to laparotomy. Laparoscopic treatment appears to result in an earlier return of bowel function and a shorter postoperative length of stay, and it will likely have lower costs.Surgical Endoscopy 08/1999; 13(7):695-8. DOI:10.1007/s004649901075 · 3.26 Impact Factor
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