Laparoscopic lysis of adhesions

The surgical treatment of small bowel obstruction is evolving. Laparoscopic exploration and adhesiolysis is increasingly being utilized. We conducted a retrospective chart review of all patients who were operated on and discharged with the diagnosis of adhesiolysis for small bowel obstruction (SBO) from July 1999 to October 2000 at Cedars-Sinai Medical Center. There were a total of 75 patients. Patients were grouped based on the type of operation: laparoscopic (lap), open, and converted. Thirty-four patients were attempted laparoscopically, 11 of those requiring conversion to open. Fifty-two patients were treated with a laparotomy. Complications contributing to morbidity were significantly lower in the lap group (P < 0.01). There was no difference in morbidity between the converted and open groups. There were fewer pneumonias and wound infections in the lap group when compared to the open group, although it did not reach statistical difference. The reduction of post-op ileus in the lap group was statistically significant (P < 0.01). Statistically significant differences between the lap and open groups were also found in estimated blood loss (EBL) (P < 0.004), length of stay (LOS) (P < 0.01), bowel resection (P < 0.01) and op-time (P < 0.003). Laparoscopic release of adhesions is a viable option in the surgical management of small bowel obstruction. A prospective randomized trial comparing both surgical techniques is needed to further validate the laparoscopic approach to small bowel obstruction.