Laparoscopic vs open surgery for patients with strangulated small bowel obstruction

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Surgical Outcomes Research

Background:

• Laparoscopic adhesiolysis is feasible for adhesive small bowel obstruction (SBO).
• Limited data exists on laparoscopic surgery for strangulated SBO.
• This study investigates the feasibility and outcomes of laparoscopic versus open surgery for strangulated SBO.

Purpose of the Study:

• To compare the outcomes of laparoscopic surgery versus open surgery for strangulated small bowel obstruction (SBO).
• To identify factors influencing conversion from laparoscopic to open surgery in strangulated SBO cases.
• To evaluate the feasibility of laparoscopic surgery as a primary approach for selected strangulated SBO patients.

Main Methods:

• Retrospective analysis of 96 patients with strangulated SBO (April 2008-September 2019).
• Comparison between 49 patients undergoing intended laparoscopic surgery and 47 undergoing open surgery.
• Subgroup analysis based on the requirement of intestinal resection.

Main Results:

• In the resection group, 50% of laparoscopic cases converted to open surgery; no significant perioperative outcome differences except for pain management.
• In the non-resection group, 15.1% of laparoscopic cases converted, with faster return to oral intake and less need for advanced pain management.
• Independent risk factors for laparoscopic-to-open conversion included elevated white blood cell count and need for intestinal resection.

Conclusions:

• Laparoscopic surgery offers superior outcomes for strangulated SBO patients not requiring intestinal resection.
• Laparoscopic surgery is a viable first-choice strategy for selected patients with strangulated SBO.
• Careful patient selection is crucial for successful laparoscopic management of strangulated SBO.