Survey of opinions on operative management of adhesive small bowel obstruction: laparoscopy versus laparotomy in the state of connecticut

This study sought to know the opinions of general surgeons registered in the state of Connecticut about their use of laparoscopic lysis of adhesions (LLA) to manage adhesive small bowel obstruction (SBO) compared with open lysis of adhesions (OLA) in terms of safety, contraindications, and outcomes.

A questionnaire was designed to gather the opinions of general surgeons registered in Connecticut on this topic. The questionnaire was administered electronically and through the mail.

Of the 205 general surgeons to whom the questionnaire was sent, 87 completed it (42% response). The respondents were evenly distributed throughout Connecticut. Of these respondents, 9% were university teaching hospital faculty, 55% were community teaching hospital based, and 36% were community nonteaching hospital based. The answers to the questions were expressed as percentages and differences between groups tested using Fisher’s exact test, with the significance level set at a P value less than 0.05. According to their self-reports, 60% of the respondents used LLA in their practice, with 38% of this group using LLA for less than 15% of their adhesive SBO cases. Compared with surgeons out of training less than 15 years, a greater number of surgeons out of training more than 15 years considered LLA to be safer (P = 0.03) and to have better outcomes (P = 0.04) than OLA. More surgeons in academic/teaching settings considered LLA to be safe than did surgeons in nonacademic/nonteaching settings (P = 0.04), and more members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)/Society of Laparoendoscopic Surgeons (SLS) considered LLA to be safe than nonmembers (P = 0.001).

Many surgeons do not perform LLA for reasons that differ from those in the surgical literature, which supports LLA. Surgeons recently trained or with membership in minimally invasive surgery (MIS) societies are more likely to use LLA. These data suggest that recent training and interest or membership in MIS associations influence surgeons’ choice for LLA. This survey demonstrated that an opportunity exists to improve patient outcomes with education about the merits of LLA in the state of Connecticut.