Conversion to open surgery in laparoscopic approach of adhesive small bowel obstruction: Predictive factors and its...

Small bowel obstruction is a common surgical emergency. Laparoscopy has been increasingly used for the treatment of adhesive small bowel obstruction (ASBO), but its indications remain unclear. In this study, we aimed to identify the risk factors for conversion to open surgery after laparoscopic ASBO treatment and evaluate the impact of conversion on short-term outcomes.

All patients diagnosed with ASBO who initially underwent laparoscopic approach after the failure of conservative treatment between December 2020 and May 2024 were reviewed. Patients were categorized into two groups based on the surgical approach: the totally laparoscopic group (group 1) and the conversion to open surgery group (group 2). The demographic, clinical, and radiological features were compared, and risk factors were identified via univariate and multivariate analyses. The intraoperative findings and postoperative outcomes were evaluated.

A total of 102 patients (43 in group 1 and 59 in group 2) were included. The time between home and admission (P ​= ​0.014) and the abdominal wall ratio (P ​< ​0.001) were significantly higher in group 2 than in group 1, whereas the number of prior abdominal surgeries (P ​= ​0.010) and the rate of beak signs were significantly lower in group 2 than in group 1. The operative time (P ​< ​0.001), blood lost (P ​< ​0.001), medical expenses (P ​< ​0.001), total hospital length of stay (P ​< ​0.001), and postoperative hospital length of stay (P ​< ​0.001) were significantly higher in group 2 than in group 1. Multivariate analysis revealed that a large abdominal wall ratio (odds ratio [OR]: 4538.7; 95 ​% confidence interval [CI]: 8.5-2426334.8; P ​= ​0.009) was a risk factor for conversion, whereas the presence of beak signs (OR: 0.186; 95 ​% CI: 0.05-0.64, P ​= ​0.008) was a significant protective factor.

A large abdominal wall ratio is an independent risk factor for conversion, whereas the presence of beak signs is a protective factor. The conversion from laparoscopic surgery to open surgery is safe with proper management of conversion indications.