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Singh SS, Shinde RK. Minimally Invasive Gastrointestinal Surgery: A Review. Cureus 2023; 15:e48864. [PMID: 38106769 PMCID: PMC10724411 DOI: 10.7759/cureus.48864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Minimally invasive surgery uses several procedures with fewer side effects (bleeding, infections, etc.), a shorter hospital stay, and less discomfort following minimally invasive surgery. Laparoscopy was one of the first forms of minimally invasive surgery. It involves doing surgery while using tiny cameras through one or more small incisions, surgical tools along with tubes. Robotic surgery is another kind of minimally invasive procedure. Along with supporting accurate, flexible, and regulated surgical procedures, it provides the physician with a three-dimensional, enlarged view of the operative site. Minimally invasive surgery continues to advance, making it an advantage for patients with a variety of illnesses. Nowadays, many surgeons prefer it to traditional surgery, which frequently necessitates a longer hospital stay and requires larger incisions. Since then, numerous surgical specialties have greatly increased their use of minimally invasive surgery. A minimally invasive procedure is preferred for the majority of patients who require gastrointestinal surgery. Minimally invasive gastrointestinal procedures are just as successful as open procedures and, in some situations, may result in more effective outcomes. While recovery from open surgeries frequently takes five to ten days in the hospital, minimally invasive surgeries are less painful for patients and hasten recovery. It is safe from the perspective of the patient and has a lower postoperative mortality rate. This procedure involves a learning curve among surgeons.
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Affiliation(s)
- Sejal S Singh
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Portela R, Dayyeh BA, Vahibe A, Ghanem OM. Pancreatic Leak After a Laparoscopic Sleeve Gastrectomy. Obes Surg 2022; 32:2825-2827. [PMID: 35689143 DOI: 10.1007/s11695-022-06137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Severe adhesions in patients with previous abdominal operations may lead to a more challenging subsequent bariatric surgery [1, 2]. In this context, sleeve gastrectomy (SG) is the preferred weight loss surgery since it solely involves stomach resection (without bowel involvement) in one abdominal compartment. Additionally, SG has lower complication rates and a shorter operative time than other bariatric procedures [3, 4]. In this paper, we present a multimedia video of the management of a pancreatic leak after SG in a patient with multiple previous abdominal surgeries. MATERIALS AND METHODS A 40-year-old female with a BMI of 36 kg/m2 and obesity-related comorbidities presented to our clinic for bariatric surgery evaluation. The patient had a history of a motor vehicle accident requiring a splenectomy, a liver laceration requiring packing and reoperation with an open abdomen for more than a month. This was followed by a hernia repair with component separation. Preoperative workup was completed, including an upper endoscopy (EGD) that was negative for esophagitis. The computed tomography (CT) scan showed an area in the left upper quadrant with no bowel loops adherent to the abdominal wall, thus a safer area for accessing the abdominal cavity (Fig. 1). The SG itself was challenging due to severe adhesions. These adhesions were between the bowel and abdominal wall, bowel and bowel, stomach and liver, and posterior stomach and pancreas (video). Once adhesiolysis was completed, the stomach was tailored successfully without intraoperative complications. The patient was discharged on postoperative day 1 with stable vitals and laboratory exams while tolerating a liquid diet. RESULTS On postoperative day 2, the patient returned to the emergency department with abdominal pain, increased heart rate (120 per minute), and a white blood cell count (WBC) of 20,000 th/µL. The CT scan showed a left upper quadrant collection with no evidence of air or contrast extravasation from the sleeve, as shown in Fig. 2. The patient became unstable and did not respond adequately to resuscitation efforts. Due to the extensive dissection in the primary operation, we elected to perform a laparoscopic exploration on an urgent basis. A collection (dark fluid) was noted in the left upper quadrant, but no sleeve staple line leak was found even with the air leak test (Fig. 2). Drainage and wash out were completed, and 2 abdominal drains were placed. Although the patient had symptomatic improvement postoperatively, an EGD with fluoroscopy was repeated, and no leak was noted (Fig. 3). The fluid evaluation showed increased lipase suggesting the diagnosis of a pancreatic leak. A liquid diet was initiated, and the initial drain in the left upper quadrant was exchanged to a higher caliber one (16F 40 cm locking loop drain). The patient was stable and eventually discharged home on postoperative day 6. Eventually, the drains were draining less than 10 mL and then downsized and removed. The patient's weight loss journey continued afterward with no other complications at 10-month follow-up. CONCLUSIONS Pancreatic leak is a rare but potentially severe complication after SG, especially in the difficult abdomen.
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Affiliation(s)
- Ray Portela
- Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Barham Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ahmet Vahibe
- Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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3
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
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Costa G, Fransvea P, Podda M, Pisanu A, Carrano FM, Iossa A, Balducci G, Agresta F. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study. Updates Surg 2020; 72:513-525. [PMID: 32088854 DOI: 10.1007/s13304-020-00726-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.
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Affiliation(s)
- Gianluca Costa
- Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "La Sapienza" University of Rome, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "La Sapienza" University of Rome, Rome, Italy
| | - Mauro Podda
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, Monserrato, 09042, Cagliari, Italy.
| | - Adolfo Pisanu
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, Monserrato, 09042, Cagliari, Italy
| | - Francesco Maria Carrano
- Department of General, Emergency and Transplant Surgery, Ospedale di Circolo e "Fondazione Macchi", ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Angelo Iossa
- Department of Medicine and Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Genoveffa Balducci
- Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "La Sapienza" University of Rome, Rome, Italy
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Sarani B, Paspulati RM, Hambley J, Efron D, Martinez J, Perez A, Bowles-Cintron R, Yi F, Hill S, Meyer D, Maykel J, Attalla S, Kochman M, Steele S. A multidisciplinary approach to diagnosis and management of bowel obstruction. Curr Probl Surg 2018; 55:394-438. [PMID: 30526888 DOI: 10.1067/j.cpsurg.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Babak Sarani
- Center for Trauma and Critical Care, George Washington University School of Medicine, Washington, DC.
| | | | - Jana Hambley
- Department of Trauma and Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Efron
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jose Martinez
- Division of Minimally Invasive Surgery, Minimally Invasive Surgery/Flexible Endoscopy Fellowship Program, University of Miami Miller School of Medicine, Miami, FL
| | - Armando Perez
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Fia Yi
- Brooke Army Medical Center, San Antonio, TX
| | - Susanna Hill
- University of Massachusetts Medical Center, Worcester, MA
| | - David Meyer
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Sara Attalla
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael Kochman
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Behman R, Nathens AB, Karanicolas PJ. Laparoscopic Surgery for Small Bowel Obstruction: Is It Safe? Adv Surg 2018; 52:15-27. [PMID: 30098610 DOI: 10.1016/j.yasu.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ramy Behman
- Division of General Surgery, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room K3W-11, Toronto, Ontario M4N 3M5, Canada
| | - Avery B Nathens
- Division of General Surgery, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D574, Toronto, Ontario M4N 3M5, Canada
| | - Paul J Karanicolas
- Division of General Surgery, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room T2-16, Toronto, Ontario M4N 3M5, Canada.
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7
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Mazzetti CH, Serinaldi F, Lebrun E, Lemaitre J. Early laparoscopic adhesiolysis for small bowel obstruction: retrospective study of main advantages. Surg Endosc 2017; 32:2781-2792. [PMID: 29218668 DOI: 10.1007/s00464-017-5979-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/05/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The problem of managing adhesional small bowel obstruction (ASBO) is still unsolved. A conservative medical attitude is privileged even if it is associated to a high rate of recurrences, while surgery is applied to cases showing no improvement after 48-72 h. Adhesiolysis via laparotomy has been the standard surgical management, but it causes other adhesions in a vicious circle. The aim of the study is to evaluate the advantages of early laparoscopic adhesiolysis as an alternative approach. METHODS From January 2010 to April 2017, 107 patients were admitted with a diagnosis of ASBO. Patients underwent medical treatment, early surgery, emergency surgery or delayed surgery after failure of medical treatment. A retrospective review and explorative statistical analysis were performed using graphical diagnostic plots, Mann-Whitney (MW) test, Kolmogorov-Smirnov (KS) test, exact binomial test, and χ 2 test. RESULTS Medical treatment led to resolution in the 77.3% of cases, but patients exhibit much more recurrences than those in the surgical group (χ 2 p < .001). They also show a longer fasting time (MW p = .027; KS p = .102), a doubled number of radiological exams (MW p < .001; KS p < .001), and more major complications than those in the early surgery group. Early surgery group is associated to shorter fasting time (MW p < .001; KS p < .001), much shorter hospital stay (MW p < .001; KS p = .002) and a smaller number of radiological exams (MW p = .005; KS p = .002) compared with delayed surgery group. The laparoscopic group shows significantly earlier regain of intestinal transit (MW p < .001; KS p = .002), shorter fasting time (MW p = .002; KS p = .008), reduced number of radiological exams (MW p = .003; KS p = .014), reduced hospital stay (MW p < .001; KS p = .005), and no more complications than the open surgery group. CONCLUSIONS Early laparoscopic surgery can be proposed as an effective alternative treatment for ASBO.
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Affiliation(s)
- Claudia Hannele Mazzetti
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Pare, Bd Kennedy 2, 7000, Mons, Belgium.
| | - Francesco Serinaldi
- School of Engineering, Newcastle University, Newcastle Upon Tyne, UK.,Willis Research Network, London, UK
| | - Eric Lebrun
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Pare, Bd Kennedy 2, 7000, Mons, Belgium
| | - Jean Lemaitre
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Pare, Bd Kennedy 2, 7000, Mons, Belgium
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8
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Mohamed Aboulkacem B, Ghalleb M, Khemir A, Souai F, Gharbi M, Ben Safta Y, Sayari S, Ben Moussa M. Laparoscopic assisted foreign body extraction from the small bowel: A case report. Int J Surg Case Rep 2017; 41:283-286. [PMID: 29545995 PMCID: PMC5709349 DOI: 10.1016/j.ijscr.2017.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/22/2022] Open
Abstract
Only one percent of foreign body ingestion needs surgery. Exploratory laparotomy has been the mainstay of treatment for patients requiring surgery however surgeons are more and more tempted to use laparoscopy in emergency setting. The increased use of minimally invasive surgery resulted in less morbidty and faster recovery after the surgical treatment of many diseases. Large scale randomized controlled trials are needed before this can be used as a standard of care. Background and aim Foreign body ingestion is a commonly seen accident in emergencies, only 1% of them will finally need surgery. Historically, exploratory laparotomy has been the mainstay of treatment for patients requiring surgery. However surgeons are more and more tempted to use laparoscopy in emergency setting. Through this case report we wanted to show in some selected cases the feasibility of laparoscopic assisted foreign body extraction from the small bowel leaving the patient with smaller scar, less morbidity and faster recovery. Case presentation A 30 year old male Inmate, ingested 40 days prior to his visit a bottom part of plastic bottle. Physical examination found an afebrile patient with a whole abdominal tenderness but no signs of peritonitis. The Abdominal Computed Tomography found a small bowel obstruction caused by a foreign body. No Radiological sign of perforation or peritonitis was found. First therapeutic strategy was to wait and see, for 24 h with no sign of improvement and the patient was taken to surgery. We opted for a laparoscopic approach y. The patient had bowel and gas movement the day after surgery. In the third day, the patient had developed a parietal abscess Treated medically. In the 10th day, after surgery the patient was discharged. Fourteenth month after the surgery, the patients is doing well with no late complication. Conclusion Laparoscopic assisted foreign body extraction from the small bowel is a good therapeutic option however Large scale randomized controlled trials are needed before this can be used as a standard of care.
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Affiliation(s)
| | | | - Alaeddine Khemir
- General Surgery Department A, Charles Nicolle Hospital, Tunisia.
| | - Faten Souai
- General Surgery Department A, Charles Nicolle Hospital, Tunisia.
| | - Maroua Gharbi
- General Surgery Department A, Charles Nicolle Hospital, Tunisia.
| | - Yacine Ben Safta
- General Surgery Department A, Charles Nicolle Hospital, Tunisia.
| | - Sofiene Sayari
- General Surgery Department A, Charles Nicolle Hospital, Tunisia.
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9
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Laparoscopic Surgery for Adhesive Small Bowel Obstruction Is Associated With a Higher Risk of Bowel Injury. Ann Surg 2017; 266:489-498. [DOI: 10.1097/sla.0000000000002369] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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10
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Jones ARE, Ragle CA, Anderson D, Scott C. Laparoscopic evaluation of the small intestine in the standing horse: Technique and effects. Vet Surg 2017; 46:812-820. [PMID: 28460413 DOI: 10.1111/vsu.12664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/21/2016] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility and clinical outcomes after laparoscopic evaluation of the small intestines via laparoscopy. STUDY DESIGN Prospective pilot study. ANIMALS Healthy adult horses (n = 5). METHODS Horses were restrained in standing stocks and received an infusion of detomidine. One port was placed in the left last intercostal space and 3 ports were placed in the right paralumbar fossa. The small intestine was run with atraumatic laparoscopic grasping forceps, from the duodenocolic plica to the ileocecal plica. Postoperative pain was scored every 4 hours for the first 48 hours. Horses were monitored via physical examinations for 2 weeks. Second look laparoscopy was repeated at 2 weeks, to run the small intestine and assess iatrogenic changes. An exploratory celiotomy was performed in 2 horses, 2 months later and long-term follow-up was recorded in 3 horses. RESULTS Laparoscopic evaluation of the entire small intestine was successfully completed twice in every horse. This evaluation lasted 39 ± 21.2 minutes (mean ± SD), while total surgery time was 73 ± 34.1 minutes. Postoperative physical examinations remained normal in all horses, and pain scores were scored as mild. The only abnormalities at second look laparoscopy consisted of multifocal petechiae and ecchymoses in all horses, resolved by 2 months in the 2 horses explored via celiotomy. Three horses with long-term follow-up were healthy 8 months after the study. CONCLUSION Running the small intestine laparoscopically is a feasible procedure in standing normal horses, and does not cause significant discomfort nor complications.
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Affiliation(s)
- Andrew R E Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Claude A Ragle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Dusty Anderson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Coryelle Scott
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
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11
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Otani K, Ishihara S, Nozawa H, Kawai K, Hata K, Kiyomatsu T, Tanaka T, Nishikawa T, Yasuda K, Sasaki K, Murono K, Watanabe T. A retrospective study of laparoscopic surgery for small bowel obstruction. Ann Med Surg (Lond) 2017; 16:34-39. [PMID: 28316782 PMCID: PMC5342981 DOI: 10.1016/j.amsu.2017.02.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/25/2017] [Accepted: 02/25/2017] [Indexed: 01/22/2023] Open
Abstract
Background Open laparotomy is widely accepted as the standard surgical treatment for small bowel obstruction (SBO). However, laparoscopic surgery has recently become a treatment option. There is no consensus on the appropriate settings for the laparoscopic treatment of SBO. The purpose of this study is to evaluate the outcomes of laparoscopic surgery for SBO. Patients and methods From January 2012 to May 2016, 48 consecutive patients underwent surgical treatment for SBO in our department. We retrospectively reviewed these cases and compared the features and the outcomes between laparoscopic and open surgery. Results Thirty-four and 14 patients underwent open surgery and laparoscopic surgery, respectively. Four of the laparoscopic cases (28.6%) were converted to open surgery. Laparoscopic surgery tended to be associated with a shorter operative time than open surgery (p = 0.066). The first postoperative oral intake was significantly earlier in patients who underwent laparoscopic surgery (p = 0.044). The duration of hospitalization after surgery and the rates of postoperative complications did not differ to a statistically significant extent. Laparoscopic treatment was accomplished in 7 out of 8 cases (87.5%) with SBO due to band occlusion. Conclusion Laparoscopic surgery for SBO is less invasive than open surgery and is equally feasible in selected patients. SBO due to band occlusion may be a preferable indication for laparoscopic surgery. In order to confirm the safety of laparoscopic treatment, and to clarify the appropriate settings for laparoscopic surgery for SBO, it will be necessary to perform further studies in a larger population and with a long follow-up period.
Surgical treatment for small bowel obstruction in 48 patients were retrospectively reviewed. Laparoscopic surgery was performed in 14 patients, and 4 cases were converted to open surgery. Laparoscopic surgery is less invasive than open surgery and is equally feasible in selected patients. Band occlusion may be a preferable indication to laparoscopic surgery.
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Affiliation(s)
- Kensuke Otani
- Corresponding author. Department of Surgical Oncology, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.Department of Surgical OncologyThe University of TokyoHongo7-3-1Bunkyo-kuTokyo113-8655Japan
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Nicolas G, Kfoury T, Shimlati R, Koury E, Tohmeh M, Gharios E, Wakim R. Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:712-719. [PMID: 27713389 PMCID: PMC5058432 DOI: 10.12659/ajcr.899664] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. CASE REPORT All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention. CONCLUSIONS Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative.
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Affiliation(s)
- Gregory Nicolas
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Tony Kfoury
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Rasha Shimlati
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Elliott Koury
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Maroon Tohmeh
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Elie Gharios
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
| | - Raja Wakim
- Department of Surgery, Mount Lebanon Hospital, Lebanese American University, Beirut, Lebanon
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13
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Pei KY, Asuzu D, Davis KA. Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database. Surg Endosc 2016; 31:2180-2186. [PMID: 27585468 DOI: 10.1007/s00464-016-5216-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/23/2016] [Indexed: 01/19/2023]
Abstract
Small-bowel obstruction (SBO) is a common disorder and constitutes a significant healthcare burden. Laparoscopic lysis of adhesions (LLOA) for SBO is predicted to decrease complications, shorten hospital stay, and cut healthcare costs compared with the open lysis of adhesions (OLOA); however, large comparison studies are lacking. We evaluated the nationwide adoption of LLOA and compared outcomes with OLOA. We retrospectively analyzed data from 9920 OLOA and 3269 LLOA cases from 2005 to 2013 using the American College of Surgeons prospective National Surgical Quality Improvement Program data set. Annual trends were evaluated using linear regression. Surgery outcomes were compared using two-sample t tests or Mann-Whitney tests. Post-surgical complications were compared using multivariable logistic regression adjusting for comorbidities. The proportion of SBO cases treated by LLOA increased nationwide by 1.6 percent per year (R 2 0.87), from 17.2 % in 2006 to 28.7 % in 2013. Patients undergoing OLOA had longer operations (66 vs 60 min, P < 0.001), longer hospital stay (8.9 vs 4.2 days, P < 0.001), and higher post-surgical complication rates (adjusted odds ratio 2.73 95 % CI 2.36-3.15, P < 0.001) when compared to LLOA. Despite the lack of prospective randomized trials comparing LLOA to OLOA, we found progressive nationwide adoption of LLOA for SBO treatment. Our large retrospective analysis demonstrated clinical benefit and reduced resource utilization for LLOA.
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Affiliation(s)
- Kevin Y Pei
- Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06510, USA. .,Yale School of Medicine, New Haven, CT, USA.
| | - David Asuzu
- Yale School of Medicine, New Haven, CT, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kimberly A Davis
- Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06510, USA.,Yale School of Medicine, New Haven, CT, USA
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14
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Cantarella F, Evoli LP, Renzi C, Cavazzoni E, Contine A, Cesari M, Donini A. Indications for the laparoscopic approach to acute small bowel obstruction: A retrospective review of 50 cases, a literature review, and a single hospital's preliminary experience. Asian J Endosc Surg 2016; 9:152-6. [PMID: 27117967 DOI: 10.1111/ases.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Abstract
Small bowel obstruction (SBO) is mainly caused by postoperative adhesions, but a broad spectrum of diseases may cause this pathogenetic condition. Laparoscopic treatment represents an efficient approach to SBO. The aim of this paper was to review a single center's experience with a minimally invasive approach to multiple pathologic scenarios causing SBO. From January 2010 to December 2012, 50 consecutive patients underwent laparoscopic surgery for mechanical SBO. In 90% of patients, the surgical procedure was totally laparoscopic, while 10% required conversion to midline laparotomy. In-hospital morbidity was 15% among totally laparoscopic patients and 40% among those who underwent conversion to midline laparotomy. Thirty-day mortality was zero. One patient died 4 months postoperatively from neoplastic disease progression; the remaining patients were free from occlusive symptoms at follow-up. The minimally invasive technique applies to a broad spectrum of cases. A larger cohort of patients seems necessary to reproduce our results and confirm the effectiveness of a laparoscopic approach to SBO.
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Affiliation(s)
- Francesco Cantarella
- Department of Surgical and Biochemical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Luca Pio Evoli
- Department of Surgery, Local health trust 1 (Azienda Sanitaria Locale), Città di Castello, Italy
| | - Claudio Renzi
- Department of Surgery, Local health trust 1 (Azienda Sanitaria Locale), Città di Castello, Italy
| | - Emanuel Cavazzoni
- Department of Surgical and Biochemical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Alessandro Contine
- Department of Surgery, Local health trust 1 (Azienda Sanitaria Locale), Città di Castello, Italy
| | - Maurizio Cesari
- Department of Surgery, Local health trust 1 (Azienda Sanitaria Locale), Città di Castello, Italy
| | - Annibale Donini
- Department of Surgical and Biochemical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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15
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Hur JH, Oh B, Kim E, Ahn EJ, Park SH, Park JM. Laparoscopic Treatment of Intestinal Obstruction. JOURNAL OF ACUTE CARE SURGERY 2016. [DOI: 10.17479/jacs.2016.6.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jae Hun Hur
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Byeonghun Oh
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Eunyoung Kim
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Eun Jung Ahn
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Sei-Hyeog Park
- Department of Surgery, National Medical Center, Seoul, Korea
| | - Jong-Min Park
- Department of Surgery, National Medical Center, Seoul, Korea
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16
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Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK. A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg 2016; 212:138-50. [PMID: 27162071 DOI: 10.1016/j.amjsurg.2016.01.030] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate whether surgical outcomes differ between laparoscopic vs open approach for adhesiolysis in patients presenting with adhesional small bowel obstruction (ASBO). DATA SOURCE A systematic review of literature on published studies reporting the surgical outcomes after laparoscopic vs open adhesiolysis for ASBO was undertaken using the principles of meta-analysis. RESULTS Fourteen comparative studies on 38,057 patients, evaluating the surgical outcomes in patients undergoing laparoscopic vs open adhesiolysis for ASBO were analyzed. Laparoscopic adhesiolysis resulted in the reduced risk of morbidity (P < .00001), mortality (P < .0001), and surgical infections (P = .003). In addition, the risk of respiratory complications, cardiac complications, bowel resection, and venous thromboembolism was lower with shorter hospitalization in laparoscopic adhesiolysis group. However, statistical equivalence was seen in variables of duration of operation and iatrogenic enterotomies. CONCLUSIONS Laparoscopic adhesiolysis for ASBO seems to have clinically proven advantage over open approach.
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Affiliation(s)
- Muhammad S Sajid
- Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK.
| | - Amir H Khawaja
- Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK
| | - Parv Sains
- Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK
| | - Krishna K Singh
- Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK
| | - Mirza K Baig
- Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK
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17
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Timofeev ME, Larichev SE, Fedorov ED, Polushkin VG, Shapoval'iants SG. [Laparoscopic diagnosis and treatment of acute early adhesive intestinal obstruction]. Khirurgiia (Mosk) 2015:46-53. [PMID: 26356059 DOI: 10.17116/hirurgia2015846-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To estimate the role of emergency laparoscopic interventions in diagnosis and treatment of acute early adhesive intestinal obstruction. MATERIAL AND METHODS It is presented the results of diagnostic and curative laparoscopic interventions in 58 patients with suspected acute early adhesive intestinal obstruction after abdominal surgery. Complex clinical-instrumental, non-invasive diagnosis does not always reveal this complication in early postoperative period. Diagnostic laparoscopy was the most informative method to assess state of abdominal cavity, to establish and characterize acute early adhesive intestinal obstruction, to determine following treatment and choice of surgery in all patients. RESULTS Diagnosis of intestinal obstruction was not confirmed in 15 (25.9%) patients based laparoscopic checkup. Acute early adhesive intestinal obstruction was established in 43 (74.1%) patients. Small intestine injuries were observed in 2 (4.5%) cases during laparoscopy. Contraindications to laparoscopic treatment of obstruction were determined in 18 (41.9%) patients in whom conventional operations were performed with complications and death in 7 (38.8%) and 3 (16.6%) cases respectively. Curative laparoscopy was applied in 23 (53.4%) patients with successful resolving of intestinal obstruction and complications in 19 (82.7%) and 4 (17.4%) cases respectively.
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Affiliation(s)
- M E Timofeev
- Research and Education Center of Abdominal Surgery and Endoscopy: Chair of Hospital Surgery No2, N.I. Pirogov Russian National Research Medical University; City Clinical Hospital No31, Moscow
| | - S E Larichev
- Research and Education Center of Abdominal Surgery and Endoscopy: Chair of Hospital Surgery No2, N.I. Pirogov Russian National Research Medical University; City Clinical Hospital No31, Moscow
| | - E D Fedorov
- Research and Education Center of Abdominal Surgery and Endoscopy: Chair of Hospital Surgery No2, N.I. Pirogov Russian National Research Medical University; City Clinical Hospital No31, Moscow
| | - V G Polushkin
- Research and Education Center of Abdominal Surgery and Endoscopy: Chair of Hospital Surgery No2, N.I. Pirogov Russian National Research Medical University; City Clinical Hospital No31, Moscow
| | - S G Shapoval'iants
- Research and Education Center of Abdominal Surgery and Endoscopy: Chair of Hospital Surgery No2, N.I. Pirogov Russian National Research Medical University; City Clinical Hospital No31, Moscow
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18
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Sharma R, Reddy S, Thoman D, Grotts J, Ferrigno L. Laparoscopic Versus Open Bowel Resection in Emergency Small Bowel Obstruction: Analysis of the National Surgical Quality Improvement Program Database. J Laparoendosc Adv Surg Tech A 2015; 25:625-30. [DOI: 10.1089/lap.2014.0446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rohit Sharma
- Santa Barbara Cottage Hospital, Santa Barbara, California
| | | | - David Thoman
- Santa Barbara Cottage Hospital, Santa Barbara, California
| | | | - Lisa Ferrigno
- Santa Barbara Cottage Hospital, Santa Barbara, California
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19
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A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg 2015; 78:13-9; discussion 19-21. [PMID: 25539198 DOI: 10.1097/ta.0000000000000491] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Differentiating between partial adhesive small bowel obstruction (aSBO) likely to resolve with medical management and complete obstruction requiring operative intervention remains elusive. We implemented a standardized protocol for the management of aSBO and reviewed our experience retrospectively. METHODS Patients with symptoms of aSBO were admitted for intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours. Laboratory values and a computed tomography scan of the abdomen and pelvis with intravenous contrast were obtained. Patients with peritonitis or computed tomography scan findings suggesting bowel compromise were taken to the operating room for exploration following resuscitation. All other patients received 80 mL of Gastroview (GV) and 40 mL of sterile water via nasogastric tube. Abdominal plain films were obtained at 4, 8, 12, and 24 hours. If contrast did not reach the colon within 24 hours, then operative intervention was performed. RESULTS Over 1 year, 91 patients were admitted with aSBO. Sixty-three patients received GV, of whom 51% underwent surgery. Twenty-four patients went directly to the operating room because of clinical or imaging findings suggesting bowel ischemia. Average time to surgery was within 1 day for the no-GV group and 2 days for the GV group. Patients passing GV to the colon within 5 hours of administration had a 90% rate of resolution of obstruction. There was a direct relationship between the duration of time before passing GV to the colon and hospital length of stay (HLOS) (r = 0.459). Patients who received GV and did not require surgery had lower HLOS (3 days vs. 11 days, p < 0.0001). CONCLUSION The GV protocol facilitated early recognition of complete obstruction. Administration of GV had diagnostic and therapeutic value and did not increase HLOS, morbidity, or mortality. LEVEL OF EVIDENCE Therapeutic study, level V. Epidemiologic study, level V.
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20
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Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A. Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 2014; 29:2525-32. [PMID: 25480627 DOI: 10.1007/s00464-014-4015-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 11/09/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic management of adhesive small bowel obstruction (SBO) has become an established technique within the domain of acute care surgery. As minimally invasive management of SBO becomes more widely accepted, there is increased need for reporting of outcomes. OBJECTIVE To compare outcomes of laparoscopic versus open surgery for adhesive SBO. METHODS Patients undergoing surgery for adhesive SBO at our institution between 2005 and 2013 were eligible for inclusion. The primary outcome was overall complication rate, while secondary outcomes included operative time, gastrointestinal (GI) function, and postoperative length of stay (LOS). Univariable analysis compared laparoscopic (including conversions) and open groups with regard to patient baseline and perioperative characteristics as well as outcomes of interest. Multivariable analysis was performed comparing the endpoint of overall complications between groups. Sensitivity analysis excluding patients who underwent bowel resection was performed to assess effect on outcomes. Factors associated with laparoscopic success, as well as impact of conversion to open on postoperative outcomes, are reported. RESULTS A cohort of 269 patients with adhesive SBO was identified: 186 patients (69.1%) underwent open surgery, 83 (30.9%) were managed laparoscopically. Within the laparoscopy group, 32 (38.6%) underwent conversion to open. Operative time was similar between groups (P = 0.506), while laparoscopy was associated with quicker recovery of GI function indicated by removal of nasogastric tube (P = 0.031) and passage of flatus (P = 0.005). Postoperative LOS was shorter (5 vs. 7 days, P = 0.031) with laparoscopy. The overall complication rate was significantly lower in the laparoscopic group (27.7 vs. 43.6%, P = 0.014), with an adjusted odds ratio (OR) for overall complications of 0.37 (P = 0.002). Following exclusion of bowel resections, secondary outcomes continued to favor laparoscopy, while reduction in overall complications trended toward significance, OR 0.47 (P = 0.050). CONCLUSION Laparoscopic surgical management of adhesive SBO was associated quicker GI recovery, shorter LOS, and reduced overall complications compared to open surgery.
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Affiliation(s)
- James Byrne
- Division of General Surgery, University Health Network, 399 Bathurst Street, 8-MP 325A, Toronto, ON, M5T 2S8, Canada,
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21
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Park B, Choo SH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY. Interval from prostate biopsy to radical prostatectomy does not affect immediate operative outcomes for open or minimally invasive approach. J Korean Med Sci 2014; 29:1688-93. [PMID: 25469071 PMCID: PMC4248592 DOI: 10.3346/jkms.2014.29.12.1688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/12/2014] [Indexed: 11/20/2022] Open
Abstract
Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the <4-week and ≥4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval ≥4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.
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Affiliation(s)
- Bumsoo Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Urology, Kangnam General Hospital, Yongin, Korea
| | - Seol Ho Choo
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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Choi BJ, Kim SJ, Lee SC, Lee JI. Single-port laparoscopic treatment of small bowel obstruction. Am J Surg 2014; 208:470-475. [PMID: 24881018 DOI: 10.1016/j.amjsurg.2014.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/03/2014] [Accepted: 01/15/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to report our initial experience with single-port laparoscopic surgery (SPLS) for small bowel obstruction (SBO). METHODS Between October 2009 and April 2013, 36 patients underwent SPLS for SBO. SPLS was performed transumbilically. Patient demographics and operative and postoperative outcomes were analyzed. RESULTS SPLS for SBO was successful in 35 patients. In 1 patient, a conversion to laparotomy was required. The median incision length, operative time, and postoperative length of stay were 2.3 cm (range, 1.5 to 5.0 cm), 115 min (range, 30 to 250 min), and 8 days (range, 3 to 26 days), respectively. The median time to resume oral intake was 3 days (range, 1 to 16 days). The intra- and postoperative complication rates were 6% and 11%, respectively. CONCLUSION SPLS was a safe and feasible therapeutic approach for SBO and may also be an excellent diagnostic tool when performed by an experienced SPLS surgeon in selected patients.
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Affiliation(s)
- Byung Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Joong-gu, Daejeon, Republic of Korea
| | - Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Joong-gu, Daejeon, Republic of Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Joong-gu, Daejeon, Republic of Korea.
| | - Jae Im Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
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23
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Should adhesive small bowel obstruction be managed laparoscopically? A National Surgical Quality Improvement Program propensity score analysis. J Trauma Acute Care Surg 2014; 76:696-703. [PMID: 24553536 DOI: 10.1097/ta.0000000000000156] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Celiotomy is the most common approach for refractory small bowel obstruction (SBO). Small reviews suggest that a laparoscopic approach is associated with shorter stay and less morbidity. Given the limitations of previous studies, we sought to evaluate outcomes of laparoscopic (L) compared with open (O) adhesiolysis for SBO, using the National Surgical Quality Improvement Program data set. METHODS Patients from the American College of Surgeons' National Surgical Quality Improvement Program 2005 to 2009 database who underwent surgery for SBO were stratified based on surgical approach. A propensity score to undergo L instead of O was calculated based on demographics, comorbidities, physiology, and laboratory values. Logistic regression was then used to determine differences in outcomes between those propensity score-matched patients who actually underwent L compared with O surgery. RESULTS There were 6,762 patients who underwent adhesiolysis. The propensity score-matching process created 222 matched patients in L and O groups. Laparoscopy was associated with significantly lower rates of any complication (odds ratio [OR] 0.41; 95% confidence interval [CI], 0.28-0.60), including superficial site infections (OR, 0.15; 95% CI, 0.05-0.49), intraoperative transfusion (OR, 0.22; 95% CI, 0.05-0.90), and shorter hospital stay (4 days vs. 10 days; p < 0.001). There was no significant difference in operative time, rates of reoperation within 30 days, or mortality. CONCLUSION Laparoscopic treatment of SBO is associated with lower rates of postoperative morbidity compared with laparotomy as well as shorter hospital stay. Laparoscopic treatment of surgical SBO is not associated with higher rates of early reoperation and seems to be associated with lower resource use. LEVEL OF EVIDENCE Therapeutic study, level IV.
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24
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Saleh F, Ambrosini L, Jackson T, Okrainec A. Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes. Surg Endosc 2014; 28:2381-6. [DOI: 10.1007/s00464-014-3486-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
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25
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Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandalà V, Mandalà S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2013; 8:42. [PMID: 24112637 PMCID: PMC4124851 DOI: 10.1186/1749-7922-8-42] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 12/19/2022] Open
Abstract
Background In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery. Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin decrease incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery. Adhesions quantification and scoring maybe useful for achieving standardized assessment of adhesions severity and for further research in diagnosis and treatment of ASBO.
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Affiliation(s)
- Salomone Di Saverio
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | | | - Marica Galati
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Nazareno Smerieri
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Walter L Biffl
- Department of Surgery, Denver Health, University of Colorado Health Sciences Denver, Denver Health Medical Center, 777 Bannock Street, Denver CO 80204, USA
| | - Luca Ansaloni
- General Surgery I, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Gregorio Tugnoli
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - George C Velmahos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Cino Bendinelli
- Department of Surgery, John Hunter Hospital and University of Newcastle, Locke Bag 1 Hunter Region Maile Centre, Newcastle, NSW 2310, Australia
| | | | - Michael D Kelly
- Upper GI Unit, Department of Surgery, Frenchay Hospital, North Bristol, NHS Trust, Bristol, UK
| | - Frederick A Moore
- Department of Surgery, University of Florida, Gainesville, FL 32610-0254, USA
| | - Vincenzo Mandalà
- Department of General and Emergency Surgery, Associated Hospitals "Villa Sofia - Cervello", Palermo, Italy
| | - Stefano Mandalà
- Department of General and Emergency Surgery, Associated Hospitals "Villa Sofia - Cervello", Palermo, Italy
| | - Michele Masetti
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Elio Jovine
- Emergency and Trauma Surgery Unit, Departments of Emergency and Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - Antonio D Pinna
- Emergency Surgery Unit, Department of General and Multivisceral Transplant Surgery, S Orsola Malpighi University Hospital, Bologna, Italy
| | - Andrew B Peitzman
- Division of General Surgery, University of Pittsburgh Physicians, Pittsburgh 15213 PA, USA
| | - Ari Leppaniemi
- Emergency Surgery, Department of Abdominal Surgery, Meilahti Hospital, University of Helsinki, Haartmaninkatu 4, 340, Helsinki FIN-00029 HUS, Finland
| | - Paul H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington, 20010 DC, USA
| | - Harry Van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101 6500 HB, Nijmegen, The Netherlands
| | - Ernest E Moore
- Department of Surgery, Denver Health, University of Colorado Health Sciences Denver, Denver Health Medical Center, 777 Bannock Street, Denver CO 80204, USA
| | - Johannes Jeekel
- Department of Surgery, Erasmus University Medical Center, PO Box 2040 3000 CA, Rotterdam, The Netherlands
| | - Fausto Catena
- Emergency Surgery Unit, Department of General and Multivisceral Transplant Surgery, S Orsola Malpighi University Hospital, Bologna, Italy.,Department of Emergency and Trauma Surgery, Maggiore Hospital of Parma, Parma, Italy
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Li MZ, Lian L, Xiao LB, Wu WH, He YL, Song XM. Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 2012; 204:779-86. [PMID: 22794708 DOI: 10.1016/j.amjsurg.2012.03.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 03/04/2012] [Accepted: 03/04/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to evaluate whether surgical outcomes differ between laparoscopy versus the open approach for adhesive small bowel obstruction. METHODS PubMed, MEDLINE, Embase, and the Cochrane Library databases were electronically searched from 1985 to 2010. The study pooled the effects of outcomes of a total of 334 patients enrolled into 4 retrospective comparative studies using meta-analytic methods. RESULTS Laparoscopic adhesiolysis was associated with a reduced overall complication rate (odds ratio = .42, .25-.70, P < .01), prolonged ileus rate (odds ratio = .28, .10-.73, P = .01) and pulmonary complication rate (odds ratio = .20, .04-.94, P = .04) compared with the open approach. No significant differences were noted for intraoperative injury to bowel rates (odds ratio = 1.93, .76-4.89, P = .17), wound infection rates (odds ratio = .44, .17-1.12, P = .08), and mortality (odds ratio = .81, .12-5.49, P = .83). CONCLUSIONS Laparoscopic adhesiolysis is advantageous in most of the analyzed outcomes. Laparoscopic treatment of small bowel obstruction is recommended by experienced laparoscopic surgeons in selected patients.
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Affiliation(s)
- Ming-Zhe Li
- Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China 510080
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Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M. Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis 2012; 14:e208-15. [PMID: 22309304 DOI: 10.1111/j.1463-1318.2012.02968.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. METHODS A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. RESULTS Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. CONCLUSION Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons.
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Affiliation(s)
- N Vettoretto
- Laparoscopic Surgery Unit, M. Mellini Hospital, Chiari, Italy.
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Laparoscopic management of acute small bowel obstruction: evaluating the need for resection. J Trauma Acute Care Surg 2012; 72:25-30; discussion 30-1; quiz 317. [PMID: 22310112 DOI: 10.1097/ta.0b013e31823d8365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute small bowel obstruction (SBO) is a common condition encountered by the on-call emergency surgeon. The role of laparoscopy in the management of SBO continues to be defined. This modality can be limited by dilated bowel and inadequate assessment of compromised tissue. This review was undertaken to determine the reliability of laparoscopic evaluation and the subsequent need for bowel resection. METHODS A retrospective review of all patients surgically managed for acute SBO between July 2005 and September 2010 was conducted. The clinical presentation, computed tomographic findings, indications for surgery, type of intervention, need for reoperation, length of stay (LOS), and outcomes were all abstracted. RESULTS A total of 119 patients were surgically managed for acute SBO during this period, 63 with initial laparoscopy and 56 with an open procedure. Twenty-five (40%) of the laparoscopy patients were converted to open, leaving 38 completed laparoscopically. Of the completed group, three patients underwent bowel resection compared with 16 in the converted group (8% vs. 64%, p < 0.0001). No patients in the completed group required a subsequent procedure for bowel resection. Twenty-three (41%) patients in the open cohort required a resection. LOS was significantly reduced in the completed group (7.7 days) compared with the converted (11.0 days, p = 0.01) and open groups (11.4 days, p = 0.002). CONCLUSIONS Overall, 32% of acute SBOs were managed solely with laparoscopy. No patients requiring a bowel resection were missed using this method of evaluation. Laparoscopic management should be considered as safe and effective initial therapy in most cases of acute SBO.
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Curado Soriano A, López Ruiz JA, Martín Pérez B, Reyes Díaz ML, Oliva Mompeán F. [Appendix constrictor ring: a rare cause of intestinal obstruction]. Cir Esp 2012; 91:60-1. [PMID: 22208677 DOI: 10.1016/j.ciresp.2011.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/24/2011] [Accepted: 07/26/2011] [Indexed: 11/28/2022]
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Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2011; 6:5. [PMID: 21255429 PMCID: PMC3037327 DOI: 10.1186/1749-7922-6-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/21/2011] [Indexed: 12/11/2022] Open
Abstract
Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment. Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.
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Affiliation(s)
- Fausto Catena
- Emergency Surgery Unit, Department of General and Multivisceral Transplant Surgery, S, Orsola Malpighi University Hospital, Bologna, Italy.
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Abstract
SBO is a common disease with multiple causes. The most significant advances over the past several years have involved, first, decision-making techniques to promptly and accurately identify patients who will require exploration, and, second, the increasing use of laparoscopic techniques. "Complete" bowel obstruction is becoming an outdated term, as treatment algorithms use predictive models and oral contrast challenges to select patients for operation without recourse to the notion of "complete obstruction." Laparoscopic techniques are gaining acceptance as a primary modality in the treatment of SBO. Appropriate patient selection is necessary for success, but successful laparoscopic SBO management can reduce postoperative pain, minimize hospital stay, and may lead to fewer adhesions, possibly preventing further adhesive SBO. Strangulation obstruction is the major cause of morbidity and mortality in SBO. Although unrecognized strangulation obstructions remain, their incidence is decreasing with the new protocols in development. Future efforts should focus on incorporating predictive models into management with the goal of eliminating unrecognized strangulation obstructions. Further refinement of the predictive models incorporating outcomes of oral contrast challenges and molecular biomarker data may allow surgeons to reach this goal. In addition, the benefit of the elimination of interpractitioner variability conferred by standardized protocols will in itself improve patient outcomes.
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Ghezzi TL, Moschetti L, Corleta OC, Abreu GPD, Abreu LPD. Analysis of the videolaparoscopy potentiality in the surgical treatment of the bowel obstruction. ARQUIVOS DE GASTROENTEROLOGIA 2010; 47:148-51. [PMID: 20721458 DOI: 10.1590/s0004-28032010000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/27/2009] [Indexed: 11/21/2022]
Abstract
CONTEXT Laparotomy is the gold standard treatment of patients with intestinal obstruction without response to clinical management. Nowadays, literature has been demonstrating the feasibility of videolaparoscopy in the treatment of intestinal obstruction. OBJECTIVES To report the clinical-epidemiological profile of patients with intestinal obstruction submitted to surgery and verify the presence of contraindications for laparoscopy. METHODS It was done a observational, descriptive and retrospective study including adults patients with intestinal obstruction submitted to surgery at Hospital de Clínicas de Porto Alegre, RS, Brazil, between January of 2004 and October of 2008. RESULTS It was included 135 patients in the study, with a total of 126 patients submitted to open surgery and 9 to laparoscopy. There was similar distribution between gender and the mean age was 59 years (SD +/- 16.9). The most frequent site of obstruction was the small bowel and the most frequent etiology was adhesions. Among the patients submitted to laparotomy, 75.4% presented with abdominal distention, 68.3% previous abdominal surgery, 11.9% body mass index >30 kg/m(2), 4.8% coagulopathy and 3.2% hemodynamic instability. Among the 135 patients, only 5 of them presented with none contraindications for videolaparoscopy. CONCLUSION The epidemiological findings of this study are similar to the ones of the worldwide literature. Indications of videolaparoscopy in retrospective analyses have the limitation of subjective evaluation of intestinal obstruction, which was included in this study as a relative contraindication to laparoscopy.
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Affiliation(s)
- Tiago Leal Ghezzi
- Surgical Sciences Graduation Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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El-labban GM, Hokkam EN. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain. J Minim Access Surg 2010; 6:95-9. [PMID: 21120065 PMCID: PMC2992668 DOI: 10.4103/0972-9941.72594] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 07/01/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic abdominal pain is a difficult complaint. It leads to evident suffering and disability, both physically and psychologically. Many diagnostic and therapeutic procedures have been described in literature, but with little proof or evidence of success. Laparoscopy is one of the modalities that could be of benefit in such cases. We aim to evaluate the diagnostic and therapeutic value of laparoscopy in cases with chronic abdominal pain. MATERIALS AND METHODS Thirty patients with chronic abdominal pain were included in this prospective descriptive cross-sectional study. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. RESULTS The most common site of pain was the periumbilical region (30%). A definitive diagnosis was made in 25 patients (83.3%), while five patients (16.7%) had no obvious pathology. Adhesions were the most common laparoscopic findings (63.3%) followed by appendiceal pathology (10%), hernia (3.3%), gall bladder pathology (3.3%), and mesenteric lymphadenopathy (3.3%). Postoperatively, pain relief was achieved in 24 patients (80%) after two months. CONCLUSION Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.
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Affiliation(s)
- Gouda M El-labban
- Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Emad N Hokkam
- Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Tierris I, Mavrantonis C, Stratoulias C, Panousis G, Mpetsou A, Kalochristianakis N. Laparoscopy for acute small bowel obstruction: indication or contraindication? Surg Endosc 2010; 25:531-5. [DOI: 10.1007/s00464-010-1206-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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Abstract
The surgical indications for laparoscopic techniques continue to expand as experience is gained. This includes patients who have had a previous open abdominal operation and require surgical intervention. In addition to the generally accepted indications for laparoscopy, conditions such as reversal of colostomy, small bowel obstruction, and early reoperation for surgical complications may be managed using minimally invasive techniques. Specific considerations in this group of patients include peritoneal access and establishing domain, lysis of adhesions, and situations that should prompt conversion.
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Affiliation(s)
- Tracey D Arnell
- Department of Surgery, New York Presbyterian-Columbia Medical Center, New York, NY 10032, USA.
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Abstract
The applicability of laparoscopy to many complex intraabdominal colorectal procedures continues to expand, and has been shown to be feasible and safe in experienced hands. Data are available on the elderly, rectal prolapse, diverticulitis, Hartman's takedown, small bowel obstruction, Crohn's disease, and ulcerative colitis. Clinically relevant advantages have been clearly demonstrated in selected patient populations. Laparoscopic surgery for benign colorectal disease should be considered in patients suitable for this approach to an abdominal operation.
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Affiliation(s)
- Y Panis
- Service de Chirurgie Digestive, Hôpital Lariboisière - Paris.
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37
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Grafen FC, Neuhaus V, Schöb O, Turina M. Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 2009; 395:57-63. [PMID: 19330347 DOI: 10.1007/s00423-009-0490-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/20/2009] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery. MATERIALS AND METHODS Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients). RESULTS Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique. CONCLUSIONS A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.
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Affiliation(s)
- Franziska Carmen Grafen
- Department of Surgery, Limmattal Hospital, Urdorferstr. 100, CH-8952, Schlieren, Zürich, Switzerland
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Farinella E, Cirocchi R, La Mura F, Morelli U, Cattorini L, Delmonaco P, Migliaccio C, De Sol AA, Cozzaglio L, Sciannameo F. Feasibility of laparoscopy for small bowel obstruction. World J Emerg Surg 2009; 4:3. [PMID: 19152695 PMCID: PMC2639545 DOI: 10.1186/1749-7922-4-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 01/19/2009] [Indexed: 12/24/2022] Open
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 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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Affiliation(s)
- Eriberto Farinella
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Francesco La Mura
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Umberto Morelli
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Lorenzo Cattorini
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Pamela Delmonaco
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Carla Migliaccio
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Angelo A De Sol
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Luca Cozzaglio
- Department of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Francesco Sciannameo
- Department of General and Emergency Surgery, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
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Darmas B. Use of barrier products in the prevention of adhesion formation following surgery. J Wound Care 2008; 17:405-8, 411. [PMID: 18833900 DOI: 10.12968/jowc.2008.17.9.30939] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Postoperative adhesion formation is a significant health-care problem with no universally accepted method of prevention. Barrier methods of prevention have been extensively tested and licensed, and this article examines the evidence.
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Affiliation(s)
- B Darmas
- Department of General Surgery, Royal Gwent Hospital, Newport, UK
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40
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Essani R, Bergamaschi R. Laparoscopic management of adhesive small bowel obstruction. Tech Coloproctol 2008; 12:283-7. [DOI: 10.1007/s10151-008-0436-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
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Pearl JP, Marks JM, Hardacre JM, Ponsky JL, Delaney CP, Rosen MJ. Laparoscopic Treatment of Complex Small Bowel Obstruction: Is It Safe? Surg Innov 2008; 15:110-3. [DOI: 10.1177/1553350608319032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Laparoscopic treatment of small bowel obstruction has many reported advantages, yet it is infrequently performed. Criticisms include reduced working space, difficult abdominal access, and bowel injury. The experience with laparoscopic treatment of small bowel obstruction to determine its safety has been reviewed. Nineteen patients underwent laparoscopic treatment of small bowel obstruction. A cut-down technique was used for abdominal access and avoided manipulation of dilated bowel. The average number of prior operations was 1.4. The average size of maximally dilated bowel was 3.5 cm, including 6 patients whose diameter was greater than 4 cm. Laparoscopic treatment was successful in 16 patients; 3 patients required laparotomy. There were no complications from abdominal access and no iatrogenic bowel injuries. This series demonstrated that abdominal access and relief of bowel obstruction can be safely performed laparoscopically in patients with complex small bowel obstruction. Neither massively dilated bowel nor multiple previous abdominal operations precluded safe conduct of the operation laparoscopically.
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Affiliation(s)
- Jonathan P. Pearl
- Department of Surgery, National Naval Medical Center, Bethesda, Maryland,
| | - Jeffrey M. Marks
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey M. Hardacre
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey L. Ponsky
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Conor P. Delaney
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael J. Rosen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Paton BL, Mostafa G, Lincourt AE, Kercher KW, Heniford BT. Profile and Significance of Emergency Colonic Resections. Am Surg 2008. [DOI: 10.1177/000313480807400405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The objectives of this study are to define the distinguishing features between elective and emergency colonic surgery. The records of adult patients who underwent elective and emergent colonic resection over a 4-year period were retrospectively reviewed. Univariate analysis was performed to compare outcomes for elective and emergency procedures and multiple logistic regression analysis was performed to identify the significant predictors of outcome. Three hundred and thirty-eight elective and 147 emergency colonic resections were performed. Diverticular disease was most common in the emergency group (43.5% vs 14.2%, P = 0.001) whereas malignancy predominated in the elective group (56.2% vs 5.4%, P = 0.001). The emergency group accounted for 54.7 per cent and 79.3 per cent of the total morbidity and mortality. Emergency colonic surgery has distinctive features and significance. Emergency surgery for colonic obstruction and total/subtotal resection are associated with higher morbidity and mortality. Diverticular disease compares favorably to other pathologies in postoperative outcome.
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Affiliation(s)
- B. Lauren Paton
- From the Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Gamal Mostafa
- From the Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Amy E. Lincourt
- From the Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kent W. Kercher
- From the Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- From the Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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43
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Hill A. The management of adhesive small bowel obstruction – An update. Int J Surg 2008; 6:77-80. [DOI: 10.1016/j.ijsu.2006.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 09/04/2006] [Accepted: 09/04/2006] [Indexed: 11/16/2022]
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Van Buren G, Teichgraeber DC, Ghorbani RP, Souchon EA. Sequential stenotic strictures of the small bowel leading to obstruction. World J Gastroenterol 2007; 13:5391-3. [PMID: 17879413 PMCID: PMC4171333 DOI: 10.3748/wjg.v13.i40.5391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Small bowel obstructions (SBOs) are primarily caused by adhesions, hernias, neoplasms, or inflammatory strictures. Intraluminal strictures are an uncommon cause of SBO. This report describes our findings in a unique case of sequential, stenotic intraluminal strictures of the small intestine, discusses the differential diagnosis of intraluminal intestinal strictures, and reviews the literature regarding intraluminal pathology.
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Affiliation(s)
- George Van Buren
- The University of Texas Health Science Center Houston, Department of Surgery, 6431 Fannin Street, MSB 4.169, Houston, Texas 77030, United States.
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Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 2007; 21:1945-9. [PMID: 17879114 DOI: 10.1007/s00464-007-9575-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 06/29/2007] [Accepted: 08/29/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute small bowel obstruction has previously been considered a relative contraindication for laparoscopic management. As experience with laparoscopy grows, more surgeons are attempting laparoscopic management for this indication. The purpose of this study is to define the outcome of laparoscopy for acute small bowel obstruction through an analysis of published cases. METHODS A literature search of the Medline database was performed using the key words laparoscopy and bowel obstruction. Further articles were identified from the reference lists of retrieved literature. Only English language studies were reviewed. We excluded studies that included patients with chronic abdominal pain, chronic recurrent small bowel obstruction, or gastric or colonic obstruction, when the data specific to acute small bowel obstruction could not be extracted. Data was analyzed based on an intention to treat. RESULTS Nineteen studies from between 1994 and 2005 were identified. Laparoscopy was attempted in 1061 patients with acute small bowel obstruction. The most common etiologies of obstruction included adhesions (83.2%), abdominal wall hernia (3.1%), malignancy (2.9%), internal hernia (1.9%), and bezoars (0.8%). Laparoscopic treatment was possible in 705 cases with a conversion rate to open surgery of 33.5%. Causes of conversion were dense adhesions (27.7%), the need for bowel resection (23.1%), unidentified etiology (13.0%), iatrogenic injury (10.2%), malignancy (7.4%), inadequate visualization (4.2%), hernia (3.2%), and other causes (11.1%). Morbidity was 15.5% (152/981) and mortality was 1.5% (16/1046). There were 45 reported recognized intraoperative enterotomies (6.5%), but less than half resulted in conversion. There were, however, nine missed perforations, including one trocar injury, often resulting in significant morbidity. Early recurrence (defined as recurrence within 30 days of surgery) occurred in 2.1% (22/1046). CONCLUSION Laparoscopy is an effective procedure for the treatment of acute small bowel obstruction with acceptable risk of morbidity and early recurrence.
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Affiliation(s)
- Bashar Ghosheh
- Department of Surgery, University of Mississippi, Jackson, MS, USA
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Seid VE, Imperiale AR, Araújo SE, Campos FGCMD, Sousa Jr AHDSE, Kiss DR, Cecconello I. A videolaparoscopia no diagnóstico e tratamento da obstrução intestinal. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-98802007000200018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A obstrução intestinal constitui complicação freqüente, de etiologia multifatorial, apresentação clínica variável e alta morbidade. Uma vez esgotados os recursos conservadores em casos específicos, a laparotomia exploradora é empregada para o diagnóstico final e tratamento em grande número de pacientes. Apesar do sucesso da via laparoscópica no manuseio de diversas afecções, a utilização desta via na abordagem inicial da obstrução do intestino delgado tem sido bastante limitada e alvo de numerosas críticas. Entretanto, o acúmulo de experiência com o método nos últimos anos, aliado ao avanço tecnológico e instrumental, têm permitido tratar número cada vez maior de pacientes obstruídos por meio do acesso laparoscópico. Assim, o surgimento de novos instrumentos como grampeadores laparoscópicos, pinças e trocáteres menos traumáticos ajudaram a tornar a videolaparoscopia factível e segura nestes pacientes. Neste artigo, os autores apresentam uma revisão sobre o papel da vídeo-cirurgia em casos selecionados de obstrução intestinal, ressaltando a contribuição dos métodos minimamente invasivos para o arsenal diagnóstico e terapêutico desta importante complicação.
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Peters AAW, Van den Tillaart SAHM. The difficult patient in gastroenterology: chronic pelvic pain, adhesions, and sub occlusive episodes. Best Pract Res Clin Gastroenterol 2007; 21:445-63. [PMID: 17544110 DOI: 10.1016/j.bpg.2007.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic pelvic pain (CPP) with or without adhesions and symptoms of intestinal occlusion is a complex but relatively common complaint. The etiology and pathophysiology of CPP and adhesions are unclear, as is their possible relation. However, it is evident that continuous abdominal pain leads to evident suffering and disability. Unfortunately, there is little proof or evidence of success for many of the currently used diagnostic and therapeutic interventions. Laparoscopy is neither the ultimate evaluation nor the panacea for CPP or intra abdominal adhesions. An integral approach to CPP has shown beneficial results. In this multidisciplinary approach dealing with the pain is far more important than finding an organic cause and cure for the pain. Equal and simultaneous attention is paid to psychosocial, sexual and somatic aspects. The treatment of adhesions depends on the extent of symptoms and complaints. Because of the questionable relation between adhesions and pain, and the probability of reformation and de novo adhesion formation after surgery, adhesiolysis should be avoided. Even for patients with signs and symptoms of small bowel obstruction a conservative treatment is often justified. These patients require careful evaluation and management. Frequent reassessment is important to rule out impending strangulation, complete obstruction or perforation. Water soluble contrast can be useful to justify prolongation of conservative treatment and by that postpone unnecessary surgery. Most adhesive small bowel obstructions resolve following conservative treatment. The unsolved questions about etiology, diagnosis, treatment and prevention, and the great individual and community burden of CPP and adhesions clearly show that further research is needed.
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Affiliation(s)
- A A W Peters
- Department of Gynaecology, Leiden University Medical Centre, K-6-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Ridgeway B, Barber MD, Walters MD, Paraiso MFR. Small bowel obstruction after vaginal vault suspension: a series of three cases. Int Urogynecol J 2007; 18:1237-41. [PMID: 17387418 DOI: 10.1007/s00192-007-0346-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 02/26/2007] [Indexed: 10/23/2022]
Abstract
Surgical correction of pelvic organ prolapse is increasingly common. The vaginal approach is often favored secondary to its limited peritoneal cavity access and low complication rates. A thorough review of the literature revealed no previous reports of primary vaginal reconstructive surgery leading to small bowel obstruction (SBO). Three patients who underwent transvaginal hysterectomy, uterosacral ligament vaginal vault suspension, and other reconstructive procedures subsequently suffered from SBO. All patients failed conservative management and required surgery. All were treated with laparoscopy initially, but two patients required laparotomy to correct iatrogenic enterotomies. The complication of SBO should be considered in the post vaginal surgery patient with abdominal pain. Though laparoscopic surgery can be considered, our experience has been discouraging. Candidate selection is critical and care should be taken to avoid enterotomy.
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Affiliation(s)
- Beri Ridgeway
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A81, Cleveland, OH 44195, USA.
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Chowbey PK, Panse R, Sharma A, Khullar R, Soni V, Baijal M. Elective laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. Surg Laparosc Endosc Percutan Tech 2007; 16:416-22. [PMID: 17277659 DOI: 10.1097/01.sle.0000213746.92901.b4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. METHODS Retrospective analysis of 253 patients who underwent therapeutic laparoscopy for recurrent small bowel obstruction from June 1996 to May 2005 was carried out. Patients with acute small bowel obstruction, bowel obstruction due to tumor, and obstructed inguinal hernias were excluded from analysis. RESULTS Laparoscopy diagnosed cause of obstruction in all except 3 (1.18%) patients. The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%). One hundred sixty nine patients were managed totally laparoscopically with adhesiolysis. Therapeutic bowel intervention other than adhesiolysis was required in 84 patients, of which 33 procedures were performed totally laparoscopically and remaining 51 procedures were completed with laparoscopically guided target incision. Five patients required conversion to open celiotomy. Iatrogenic enterotomies occurred in 3 patients and small bowel perforation during manipulation occurred in 1 patient. Postoperative procedure-related complications were seen in 44 patients. There was one mortality due to postoperative arrhythmia and cardiac failure. CONCLUSIONS Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases.
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Affiliation(s)
- Pradeep K Chowbey
- Minimal Access and Bariatric Surgery Center, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, Nogueras JJ, Vernava AM, Wexner SD. Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients' outcome and cost-effectiveness. Surg Endosc 2007; 21:742-6. [PMID: 17332956 DOI: 10.1007/s00464-007-9212-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 12/12/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Numerous studies have demonstrated the feasibility of laparoscopy in the management of acute adhesive small-bowel obstruction (AASBO). However, comparative data with laparotomy are lacking. The aim of this study was to compare laparoscopy and laparotomy for the treatment of AASBO in terms of patient outcome and cost-effectiveness. METHODS A retrospective chart review of all patients who underwent surgery for AASBO from 1999 to 2005 was conducted. Data recorded included operative and postoperative course, among others. Operative and total hospital charges were estimated from the Patient Accounting System. RESULTS Thirty-one patients who underwent laparoscopy were matched to a similar group of patients who underwent laparotomy. In the laparoscopy group, four patients (13%) had a laparoscopy-assisted procedure and ten patients (32%) were converted. The laparoscopy group was subdivided into laparoscopy, laparoscopy-assisted, converted, and assisted-converted subgroups. In the majority of the patients, AASBO was secondary to a single band. Overall morbidity was significantly higher in the laparotomy group (p = 0.007). Morbidity rates were statistically significant between the laparoscopy and assisted-converted subgroups (p = 0.0001) but not between the laparotomy group and assisted-converted subgroup (p = 0.19). Median hospital stay and median time to first bowel movement were significantly shorter in the laparoscopy group. Charge data were available for only the last three years of the study. Operative charges and total hospital charges were similar between the laparoscopy and the laparotomy groups (p = 0.14 and p = 0.10, respectively). There was a significant difference in total hospital charges between the laparoscopy subgroup and laparotomy group (p = 0.03). CONCLUSIONS Laparoscopy for AASBO is associated with reduced hospital stay, early recovery, and decreased morbidity. Laparoscopy-assisted and converted surgeries do not differ significantly from laparotomy in regard to patient outcome. Operative and total hospital charges are similar for both laparoscopy and laparotomy.
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Affiliation(s)
- M Khaikin
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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