Laparoscopic surgery in acute small bowel obstruction

Advances in laparoscopic surgery have drastically modified not only the thinking of most general surgeons, but have also helped to change the approach to many disease processes. The tremendous success of the laparoscopic approach to biliary tract disease as well as to appendicitis, trauma, and even colonic disease led us to consideration and evaluation of laparoscopy as a tool in the management of patients with acute and chronic intestinal obstruction. Forearmed with laparoscopic skills gained performing laparoscopic cholecystectomy, common bile duct exploration, appendectomy, and laparoscopic colon resection and cognizant of the many patients with simple adhesions, internal herniae, and volvulus, we included all patients with suspected intestinal obstruction who did not have resolution of signs and symptoms with conservative treatment in this study. Patients were treated initially with intravenous fluids, nasogastric suction, and correction of electrolyte disturbances. Laparoscopy was performed on 23 patients during the period of May 1991 through April 1993 with resolution of the problem laparoscopically in 20. Details of pathological processes, operations performed, technique, and guidelines for laparoscopy are included.