Laparoscopic Versus Open Approach for Strangulated Small Bowel Obstruction: A Propensity Score-Matched Analysis

Laparoscopic surgery has gradually gained acceptance for abdominal surgical emergencies; however, limited reports exist on laparoscopic surgery for strangulated small bowel obstruction (SSBO). We aimed to demonstrate the efficacy and feasibility of laparoscopic surgery for SSBO.

In this single-center retrospective study, patients who underwent emergency surgery for SSBO between January 2014 and December 2024 were included and divided into laparoscopy and open groups. Propensity score matching (PSM) was performed to compare the primary outcomes-intraoperative and short-term postoperative outcomes-between the groups. Logistic regression analysis was used to identify the factors associated with the conversion from laparoscopic to open surgery as secondary outcomes.

A total of 123 patients were included in this study, of whom 39 (31.7%) were assigned to the laparoscopy group. After PSM, the overall rate of the Clavien-Dindo grade ≥ II postoperative complications was significantly lower in the laparoscopy than the open group (7.4% vs. 29.6%; p = 0.036). Of the 39 patients in the laparoscopy group, 10 (25.6%) were converted from laparoscopic to open surgery. The number of previous laparotomies (odds ratio: 4.036, 95% confidence interval: 1.189-13.701, and p = 0.025) and a history of gastrointestinal surgery (odds ratio: 6.125, 95% confidence interval: 1.263-29.699, and p = 0.024) were identified as factors significantly associated with conversion from laparoscopic to open surgery in patients with SSBO.

Our study suggests that laparoscopic surgery for SSBO is beneficial for reducing the occurrence of postoperative complications. However, laparoscopic surgery should be performed in patients with a history of multiple laparotomies or gastrointestinal surgery, considering the possibility of conversion to open surgery.