The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction
Sebastian-Valverde, Enric (Hospital del Mar (Barcelona, Catalunya))
Poves, Ignasi (Institut Hospital del Mar d'Investigacions Mèdiques)
Membrilla-Fernández, Estela (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Pons-Fragero, María José (Hospital del Mar (Barcelona, Catalunya))
Grande, L (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Fecha:	2019
Resumen:	Postoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity. A retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO. 262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38. 5%. Patients in the laparoscopic group were younger (p < 0. 001), had fewer previous abdominal operations (p = 0. 001), lower ASA grade (p < 0. 001), and less complex adhesions were found (p = 0. 001). Operative time was longer in the open group (p = 0. 004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67. 9%, p < 0. 001), lower mortality (p = 0. 026), earlier oral intake (p < 0. 001) and shorter hospital stay (p < 0. 001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2. 89; 95% CI 1. 1-7. 6; p = 0. 033). Laparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Tissue adhesions ; Small intestine ; Intestinal obstruction ; Laparoscopy ; Length of stay
Publicado en:	BMC Surgery, Vol. 19 (april 2019) , ISSN 1471-2482

DOI: 10.1186/s12893-019-0504-x
PMID: 31014318

7 p, 346.3 KB

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