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Laparoscopic management of acute small-bowel obstruction
I M Ibrahim1, F Wolodiger, B Sussman
1Department of Surgery, Section of Laparoscopic Surgery, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
Background:
A retrospective review is given of the authors' experience with a consecutive series of acute small-bowel obstruction unresponsive to medical management.
Methods:
There were 33 exploratory laparoscopies. The etiology was accurately diagnosed in 100% of the cases. Twenty-five (76%) were secondary to postoperative adhesions, of which 18 (72%) were successfully treated by laparoscopic lysis of adhesions. Minilaparotomy was needed to treat iatrogenic perforation (two), gangrenous bowel (one), and Meckel's diverticulectomy (one). Formal laparotomy was utilized for small-bowel resection (two), malignant adhesions (two), and intolerance of pneumoperitoneum (one). Four cases of incarcerated hernias were treated by conventional herniorrhaphy.
Results:
Overall, 67% of our cases were spared formal laparotomy.
Conclusion:
We conclude that laparoscopy is an excellent diagnostic modality in acute small-bowel obstruction, the majority of which can be simultaneously managed laparoscopically. Laparotomy should be reserved for malignant adhesions, surgical misadventure, or when the pathology dictates.