Minimally invasive versus open surgery for adhesive small bowel obstruction: a systematic review and meta-analysis

Adhesive small bowel obstruction (ASBO) is a common surgical emergency. However, open adhesiolysis has traditionally been the standard operative approach after failed conservative management. The aim was comparing postoperative outcomes between laparoscopic and open adhesiolysis in ASBO.

A systematic review and meta-analysis was conducted according to PRISMA 2020 and Cochrane guidelines. PubMed, Embase, Scopus, Web of Science, and BVS were searched from inception to September 2025. Randomized controlled trials (RCTs) and comparative cohort studies evaluating laparoscopic versus open adhesiolysis in adults with ASBO were included. Random-effects models were applied. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using ROBINS-I and RoB 2. Certainty of evidence was evaluated with GRADE.

Fifteen studies (22,409 patients; 14 retrospective cohorts and 1 RCT) were included. Meta-analysis of observational studies showed that laparoscopic adhesiolysis was associated with lower postoperative mortality (13 studies; RR 0.33, 95% CI 0.24 to 0.45; I² = 0%) and fewer overall complications (13 studies; RR 0.46, 95% CI 0.33 to 0.64; I² = 80.4%). No significant differences were observed in reintervention (7 studies; RR 0.93, 95% CI 0.70 to 1.24; I² = 0%) or recurrence (2 studies; RR 1.88, 95% CI 0.27 to 13.15; I² = 52.2%). Laparoscopy was associated with shorter hospital stay (MD - 3.49 days, 95% CI - 4.22 to - 2.76) and operative time (MD - 34.34 min, 95% CI - 41.04 to - 27.65). Evidence certainty was low to very low.

In selected adults with ASBO, laparoscopic adhesiolysis is associated with improved early postoperative outcomes compared with open surgery, although overall certainty of evidence remains limited.