Laparoscopic treatment of mechanical small bowel obstruction

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Published Mar 4, 2011
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Vol. 89 No. 3 (2011): Issue Mar 2011

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Brahim Ghariani
Hichem Houissa
Farouk Sebai

Abstract

Background: A history of abdominal surgery have long been considered a contraindication to laparoscopy. There was a reluctance to advocate the use of laparoscopy in mechanical bowel obstruction due to technical difficulties related to a distended small intestine, and a small work space.
Aims: To report the results of laparoscopic treatment of small bowel mechanical obstruction and to study the factors for conversion to laparotomy.
Methods: Our study is retrospective, having compiled 32 patients between January 2001 and December 2009. The average age was 35 years (20-54). There were 17 men and 15 women. History of laparotomies were noted in 27 patients. Were excluded from this study patients with strangulated hernia or eventration. An analysis was conducted to determine the conversion factors to laparotomy
Results: The flanges or postoperative adhesions were responsible for 27 of the 32 intestinal obstructions (84%). In 24 cases there was a single flange or localized adhesions treated by simple section successfully in 18 patients (56% of cases). A conversion was performed in 14 cases (44%). the median time to recovery of intestinal transit was shorter after laparoscopic surgery completely after conversion (1.5 vs. 2.5 days, p = 0.004). Similarly, the median length of postoperative stay was shorter in the absence of conversion (2.4 vs 7, p <0.001). Statistical analysis identified four factors related to conversion, which are: the presence of peritoneal signs, the number of brackets> 1, and the need for a bowel resection.
Conclusion: Laparoscopy is an option for the treatment of mechanical bowel obstruction when performed in selected patients.
His best indication could be the occlusion of single flange. This alternative to laparotomy could reduce adhesion formation and potentially reduce future episodes of obstruction.

Keywords:

Bowel obstruction, laparoscopy, surgery, flanges, adhesions

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References

  1. Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 1997; 557:5-9.
  2. Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg 2000; 87:1240-74.
  3. Adams S, Wilson T, Brown AR. Laparoscopic management of acute small bowel obstruction. Aust NZ J Surg 1993; 63:39-41
  4. Bailey IS, Rhodes M, O'Rourke N, et al. Laparoscopic management of acute small bowel obstruction. Br J Surg 1998; 85:84-7.
  5. Navez B, Arimont J-M, Guiot P. Laparoscopic approach in acute small bowel obstruction. A review of 68 patients. Hepatogastroenterology 1998; 45:2146-50.
  6. Strickland P, Lourie DJ, Suddleson EA, et al. Is laparoscopy safe and effective for treatment of acute small-bowel obstruction?. Surg Endosc 1999; 13:695-8.
  7. Agresta F, Piazza A, Michelet I, et al. Small bowel obstruction-laparoscopic approach. Surg Endosc 2000;14:154-6.
  8. Wullstein C, Gross E. Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 200 90:1147-51.
  9. Menzies D, Ellis H. Intestinal obstruction from adhesions - how big is the problem? Ann R Coll Surg Engl 1990; 72:60-3.
  10. Parent S. Tortuvaux JM, Deneuville M, Besler L, Boissel P. What are the small bowel obstructions to operate and how to do it? Acta Gastroenterol Belg 1996 : 59 : 150-l.
  11. Franklin ME, Dorman JP, Pharand D. Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 1994; 4: 289-296
  12. Sfairi A, Patel JC, La c?lioscopie dans le traitement des occlusions aigues du grêle: résultats pre´liminaires. Presse Med 1995: 24:1727-1730
  13. Nezhat CR, Nezhat FR, Metzger DA, Luciano AA. Adhesion reformation after reproductive surgery by videolaparoscopy. Fertil Steril 1990; 53: 1008-11.
  14. Operative laparoscopy Study Group Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Fertil Steril 1991 ; 55 : 700-4.
  15. Garrard CL, Clements RH, Nanney L, et al. Adhesion formation is reduced after laparoscopic surgery. Surg Endosc; 1999; 13:10-3.
  16. De Wilde RL. Goodbye to late bowel obstruction after appendicectomy. Lancet 1991:338: 1112
  17. Levard H, Mouro J, Schiffino L, Karayel M, Berthelot G, Dubois F. Traitement c?lioscopique des occlusions aigu&s du grêle. Ann Chir 1993; 47 : 497-501.
  18. Benoist S, De Watteville JC, Gayral F. Place de la c?lioscopie dans les occlusions aigues du grêle. Gastroenterol Clin Biol 1996; 20: 357- 361
  19. Ibrahim IM, Wolodigere, Sussman B, Kahn M, Silvestri F,Sabar A. Laparoscopic management of acute small-bowel obstruction. Surg Endosc 1996; 10 : 1012-5.
  20. Chévre F, Renggli JC, Groebli Y, Tschantz P. Traitement laparoscopique des occlusions du grêle sur brides. Ann Chir 1997; 51: 1092-S.
  21. Henry C, Smadja C, Vons C, Bobocescu E, Mariette D, Tahrat M, et al.-Résultats du traitement c?lioscopique des urgences abdominales. Ann Chir 1998: 52 : 223-8
  22. Suter M, Zermatten P, Halkic N, et al. Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Surg Endosc 2000; 14:478-83.
  23. Taourel PG, Fabre JM, Pradel JA, et al. Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. AJR Am J Roentgenol 1995;165:1187-92.
  24. Donckier V, Closset J, Van Gansbeke D, et al. Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg 1998;85:1071-4.
  25. Balthazar EJ. CT of small bowel obstruction. AJR 1994; 162: 255-61.