Email updates

Keep up to date with the latest news and content from World Journal of Emergency Surgery and BioMed Central.

Open Access Research article

Feasibility of laparoscopy for small bowel obstruction

Eriberto Farinella1*, Roberto Cirocchi1, Francesco La Mura1, Umberto Morelli1, Lorenzo Cattorini1, Pamela Delmonaco1, Carla Migliaccio1, Angelo A De Sol1, Luca Cozzaglio2 and Francesco Sciannameo1

Author Affiliations

1 Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy

2 Department of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy

For all author emails, please log on.

World Journal of Emergency Surgery 2009, 4:3  doi:10.1186/1749-7922-4-3

Published: 19 January 2009

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.