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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2009

Open Access 01-12-2009 | Research article

Feasibility of laparoscopy for small bowel obstruction

Authors: Eriberto Farinella, Roberto Cirocchi, Francesco La Mura, Umberto Morelli, Lorenzo Cattorini, Pamela Delmonaco, Carla Migliaccio, Angelo A De Sol, Luca Cozzaglio, Francesco Sciannameo

Published in: World Journal of Emergency Surgery | Issue 1/2009

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Abstract

Background

Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity.

Methods

We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources.

Results

The feasibility of diagnostic laparoscopy is high (60–100%), while that of therapeutic laparoscopy is low (40–88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon.

Conclusion

Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.
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Metadata
Title
Feasibility of laparoscopy for small bowel obstruction
Authors
Eriberto Farinella
Roberto Cirocchi
Francesco La Mura
Umberto Morelli
Lorenzo Cattorini
Pamela Delmonaco
Carla Migliaccio
Angelo A De Sol
Luca Cozzaglio
Francesco Sciannameo
Publication date
01-12-2009
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2009
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/1749-7922-4-3

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