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Updated: Aug 11, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Single-centre retrospective cohort study on laparoscopic and open adhesiolysis for adhesional bowel obstruction in
Solange Bramer1, Stavros Loukogeorgakis1, Simon Blackburn1
1Great Ormond Street Hospital, London, United Kingdom.
Insights
Laparoscopic adhesiolysis in children is safe and effective, offering shorter hospital stays for adhesional bowel obstruction (ABO). However, a significant portion requires conversion to open surgery, with similar complication rates for both procedures.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Adhesions are a common complication following intra-abdominal surgery, potentially leading to adhesional bowel obstruction (ABO).
- Surgical intervention, specifically adhesiolysis, is often required to manage ABO.
- Laparoscopic and open surgical approaches are utilized for adhesiolysis, each with distinct characteristics and outcomes.
Purpose of the Study:
- To compare the characteristics and outcomes of laparoscopic versus open adhesiolysis in pediatric patients.
- To evaluate the safety and feasibility of laparoscopic adhesiolysis in children with ABO.
- To identify factors influencing conversion rates from laparoscopic to open adhesiolysis.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) undergoing surgical management for ABO.
- Data collected from electronic medical records between September 2013 and July 2024.
- Comparison of patient demographics, index operations, surgical approach (laparoscopic vs. open), conversion rates, length of stay, and post-operative outcomes.
Main Results:
- 111 pediatric patients were analyzed; 56% underwent laparoscopic adhesiolysis, with a 46% conversion rate to open surgery.
- Laparoscopic adhesiolysis was associated with a significantly shorter length of hospital stay compared to open adhesiolysis.
- Post-operative complication rates and recurrent ABO were similar between laparoscopic and open adhesiolysis groups.
- Bowel resection was more common in laparoscopic cases converted to open surgery.
Conclusions:
- Laparoscopic adhesiolysis is a safe and feasible option for pediatric patients with ABO.
- The laparoscopic approach offers a shorter hospital stay without increasing complication or recurrence rates.
- A high conversion rate to open surgery necessitates careful patient selection and surgical planning.
Aims:
Adhesions are a recognised complication of intra-abdominal surgery and can result in adhesional bowel obstruction (ABO), which often requires adhesiolysis. This retrospective cohort study aimed to compare characteristics and outcomes of patients undergoing laparoscopic and open adhesiolysis at a tertiary paediatric surgery centre.
Methods:
Following institutional approval, a retrospective review of electronic medical records was performed for patients <18 years old managed surgically for ABO between September 2013 and July 2024.
Results:
Of 111 patients identified, 62 (56%) had laparoscopic adhesiolysis, with 46% requiring conversion to open. Median age at surgery was lower for open than laparoscopic adhesiolysis (five vs eight years, p = 0.01), although sex and presence of co-morbidities was similar. The most common index operation for laparoscopic adhesiolysis was appendicectomy (27%), compared to surgery for necrotising enterocolitis for open adhesiolysis (16%, p = 0.01). Sub-group analysis of laparoscopic adhesiolysis converted to open showed similar distribution of sex, age, and comorbidities, but bowel resection was more common in the latter (3% vs 32%, p = 0.01). Open adhesiolysis was associated with double the length of hospital stay compared to laparoscopic adhesiolysis (p < 0.01). The rate of post-operative complications and recurrent ABO was similar between both groups.
Conclusion:
Our findings suggest that laparoscopic adhesiolysis is safe and feasible in children, with a significantly shorter length of stay, a similar rate of post-operative complications and recurrent adhesional bowel obstruction, but a high rate of conversion to open surgery.
