[Role of celioscopy in acute obstructions of the small intestine]

The aim of this study was to evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute small bowel obstruction.

Thirty five patients, with less than three abdominal incisions, who had undergone initial laparoscopy for acute small bowel obstruction, were reviewed. The small bowel was mobilized to determine the cause and site of obstruction.

In 31 cases, small bowel obstruction was caused by a single or numerous obstructing bands. Among 31 cases of adhesions, laparoscopic treatment of intestinal obstruction was possible in 16 cases (51.6%). In 15 cases, laparoscopy had to be completed by laparotomy: numerous adhesions could not be divided in 12 cases; intestinal ischemia which required resection was present in 3 cases. There was no hospital mortality and postoperative complications occurred in 19% of cases. Multivariate analysis demonstrated a relation between need to complete laparoscopy by laparotomy and two factors : presence of signs of peritoneal irritation (P < 0.05) and intestinal obstruction caused by numerous adhesions or bands (P < 0.05). Mean hospital stay and postoperative ileus were significantly shorter in the "laparoscopy" group than in the "laparoscopy + laparotomy" group.

Laparoscopic treatment of acute small bowel obstruction is difficult and was possible in only half of the cases. The first port should be inserted by open technique to avoid the risk of perforation of distented small bowel. When laparoscopy shows numerous adhesions, laparoscopic treatment should not be pursued, and laparotomy should be recommended to avoid the risk of visceral perforation.