Laparoscopic management of acute small-bowel obstruction.

Abstract

BACKGROUND:

A retrospective review is given of the authors' experience with a consecutive series of acute small-bowel obstruction unresponsive to medical management.

METHODS:

There were 33 exploratory laparoscopies. The etiology was accurately diagnosed in 100% of the cases. Twenty-five (76%) were secondary to postoperative adhesions, of which 18 (72%) were successfully treated by laparoscopic lysis of adhesions. Minilaparotomy was needed to treat iatrogenic perforation (two), gangrenous bowel (one), and Meckel's diverticulectomy (one). Formal laparotomy was utilized for small-bowel resection (two), malignant adhesions (two), and intolerance of pneumoperitoneum (one). Four cases of incarcerated hernias were treated by conventional herniorrhaphy.

RESULTS:

Overall, 67% of our cases were spared formal laparotomy.

CONCLUSION:

We conclude that laparoscopy is an excellent diagnostic modality in acute small-bowel obstruction, the majority of which can be simultaneously managed laparoscopically. Laparotomy should be reserved for malignant adhesions, surgical misadventure, or when the pathology dictates.

• Authors: I M Ibrahim, F Wolodiger, B Sussman, M Kahn, F Silvestri, A Sabar
• Journal: Surgical endoscopy (Surg Endosc) Vol. 10 Issue 10 Pg. 1012-4; discussion 1014-5 (Oct 1996) ISSN: 0930-2794 [Print] Germany
• PMID: 8864097 (Publication Type: Journal Article)

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Feasibility Studies
• Female
• Humans
• Intestinal Obstruction (surgery)
• Laparoscopy
• Laparotomy
• Male
• Middle Aged
• Retrospective Studies