Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure?

Details

Serval ID
serval:BIB_E350124BC25B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure?
Journal
Surgical Endoscopy
Author(s)
Suter  M., Zermatten  P., Halkic  N., Martinet  O., Bettschart  V.
ISSN
0930-2794 (Print)
Publication state
Published
Issued date
2000
Volume
14
Number
5
Pages
478-483
Notes
DA - 20000901
LA - eng
PT - Journal Article
SB - IM
Abstract
BACKGROUND: Laparoscopy is used increasingly for the management of acute abdominal conditions. For many years, previous abdominal surgery and intestinal obstruction have been regarded as contraindications to laparoscopy because there is an increased risk of iatrogenic bowel perforation. The role of laparoscopy in acute small bowel obstruction remains unclear. METHODS: Since 1995, data from patients undergoing laparoscopic surgery have been entered prospectively into a database. Patients who underwent surgery before 1995 were added retrospectively to the same database. The charts of all patients treated surgically for mechanical small bowel obstruction were reviewed. Univariate analysis was performed to identify factors associated with success or failure, especially intraoperative complications, conversion, and postoperative morbidity. Stepwise logistic regression was used to assess for independent variables. RESULTS: This study included 83 patients (56 women and 27 men) with a mean age of 56 years (range, 17-91 years). Conversion was necessary in 36 cases (43%). Laparoscopy alone was successful in 47 patients (57%). Intraoperative complications were noted in 16% and postoperative complications in 31% of the patients. Eight reoperations (9%) were necessary. Mortality was 2.4%. Duration of surgery (p < 0.001) and a bowel diameter exceeding 4 cm (p = 0. 02) were predictors of conversion. No risk factor for intraoperative complication was identified. Accidental bowel perforation (p = 0. 008) and the need for conversion (p = 0.009) were the only independent factors associated with an increased risk of postoperative complications. CONCLUSIONS: Laparoscopic management of small bowel obstruction is possible in roughly 60% of the patients selected for this approach. Morbidity is lower, resumption of a normal diet is faster, and hospital stay is shorter than with patients requiring conversion. No clear predictor of success or failure was identified, but intraoperative complications must be avoided. If the surgeon is widely experienced in advanced laparoscopic surgery and there is a liberal conversion policy, laparoscopy is a valuable alternative to conventional surgery in the management of acute small bowel obstruction
Keywords
Acute Disease/Adolescent/Adult/Aged/Aged,80 and over/Databases,Factual/Female/Humans/Intestinal Obstruction/surgery/Intestine,Small/Intraoperative Complications/Laparoscopy/mortality/Male/Middle Aged/Postoperative Complications/Regression Analysis/Reoperation/Treatment Outcome
Pubmed
Web of science
Create date
18/02/2008 14:30
Last modification date
20/08/2019 17:07
Usage data