Laparoscopic treatment of small bowel obstruction: Prospective evaluation in 30 patients

Abstract

Laparoscopic treatment of small intestinal obstruction is associated with immediate advantages and it may be expected that the recurrence rate will be decreased because of the reduction of wound scars. Between September 1989 and October 1994, 30 patients (19 men and 11 women), mean age 54.4 years, underwent initial laparoscopy for acute small intestinal obstruction. These patients had undergone a total of 52 (1.6 per patient) laparotomies, 15 years before, on average. One patient had never been operated on, 15 had one previous laparotomy, seven had two, five had three, and two had four previous laparotomies. Laparoscopic treatment of intestinal obstruction was possible in 10 cases, including three cases of bands, and six instances of adhesion and one small bowel strangulation in a trocar hole from a previous laparoscopy. In 20 cases, laparoscopy had to be completed by laparotomy, 17 immediately and three secondarily. The cause of immediate failure was the impossibility of finding and/or treating the cause of the obstruction in 11 instances, and there were four cases of intestinal injuries, one case of intestinal necrosis which required resection, and one case of missed right colonic carcinoma. The causes of secondary failure were incomplete liberation of adhesions, secondary volvulus, and missed left colonic carcinoma in one case each. Mean hospital stay and postoperative ileus were significantly shorter in the laparoscopy group than in the laparoscopy + laparotomy group (P < 0.001). Three complications, with one death, were noted in the laparoscopy + laparotomy group. Thus, laparoscopic treatment of intestinal obstruction seems possible but in less than half of cases. Failures are related to the difficulty with which the abdomen may be explored. Laparoscopic treatment should not be pursued in cases with problems. When successful, the immediate postoperative course is simpler. Its role in the prevention of recurrences is difficult to assess because of the unavailability of patients for long-term follow-up.

Key Words:

• small intestinal obstruction
• laparoscopy