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Low incidence of adhesion-related bowel obstruction after laparoscopic colorectal surgery
Danny Rosin1, Oded Zmora, Aviad Hoffman
1Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel. drosin@mac.com
Background:
Postoperative adhesions are a major cause of morbidity, accounting for approximately 5% of the readmissions of surgical patients. Bowel obstruction is attributed to adhesions in more than half of the cases, many of which are following colon and rectal surgery. Laparoscopic surgery has the potential advantage of reduced adhesion formation owing to attenuated surgical trauma, less tissue handling, and smaller scars. However, the translation of these advantages to a reduced rate of bowel obstruction has not been sufficiently demonstrated. The aim of this study was to assess the rate of adhesion-related bowel obstruction after laparoscopic colon and rectal surgery.
Methods:
Data regarding all cases of laparoscopic colon and rectal surgery were prospectively collected. Information relative to demographics, surgical procedures, and follow-up was analyzed, and patients who were readmitted for bowel obstruction were identified.
Results:
Over a period of 8 years, 306 patients, at a mean age of 63 years, had a laparoscopic colon and rectal operation in our department-122 for benign conditions and 184 for malignant disease. The mean length of follow-up was 38 months. Six cases (2%) of bowel obstruction, which were unrelated to hernia or advanced cancer, were identified. Two patients had a history of open surgery, in addition to the laparoscopic procedure, so adhesions could be attributed solely to the laparoscopic procedure in 4 patients, which consisted of 1.3% of the total study group. Obstruction occurred within 2 weeks of surgery in 2 patients, and one early reoperation was required.
Conclusions:
The incidence of adhesion ileus after laparoscopic colon and rectal surgery appears to be very low. This long-term benefit of laparoscopic surgery should be considered when comparing this technique to its open counterpart.
Insights
Laparoscopic colon and rectal surgery shows a very low incidence of adhesion-related bowel obstruction. This finding suggests a long-term benefit of minimally invasive techniques over open surgery for preventing postoperative complications.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Postoperative adhesions are a significant cause of morbidity, leading to approximately 5% of surgical patient readmissions.
- Adhesions are responsible for over half of bowel obstruction cases, particularly after colon and rectal surgery.
- Laparoscopic surgery offers potential benefits in reducing adhesion formation due to less trauma and tissue handling.
Purpose of the Study:
- To evaluate the rate of adhesion-related bowel obstruction following laparoscopic colon and rectal surgery.
- To determine if the theoretical advantages of laparoscopic surgery translate to a reduced incidence of bowel obstruction.
Main Methods:
- Prospective data collection of all laparoscopic colon and rectal surgeries over 8 years.
- Analysis of patient demographics, surgical procedures, and follow-up information.
- Identification of patients readmitted for bowel obstruction.
Main Results:
- Six cases (2%) of bowel obstruction, unrelated to hernia or advanced cancer, were identified in 306 patients.
- Adhesions solely attributable to laparoscopic procedures occurred in 4 patients (1.3%).
- Two obstructions occurred within 2 weeks of surgery, requiring one early reoperation.
Conclusions:
- The incidence of adhesion ileus after laparoscopic colon and rectal surgery is notably low.
- This low rate represents a significant long-term benefit of laparoscopic surgery compared to open procedures.
