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Early laparoscopic adhesiolysis for small bowel obstruction: retrospective study of main advantages

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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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Authors and Affiliations

  1. Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Pare, Bd Kennedy 2, 7000, Mons, Belgium

    Claudia Hannele Mazzetti, Eric Lebrun & Jean Lemaitre

  2. School of Engineering, Newcastle University, Newcastle Upon Tyne, UK

    Francesco Serinaldi

  3. Willis Research Network, London, UK

    Francesco Serinaldi

Authors
  1. Claudia Hannele Mazzetti
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  2. Francesco Serinaldi
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  3. Eric Lebrun
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  4. Jean Lemaitre
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Correspondence to Claudia Hannele Mazzetti.

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Disclosures

Claudia Hannele Mazzetti, Francesco Serinaldi, Eric Lebrun, and Jean Lemaitre have no conflicts of interest or financial ties to disclose.

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Mazzetti, C.H., Serinaldi, F., Lebrun, E. et al. Early laparoscopic adhesiolysis for small bowel obstruction: retrospective study of main advantages. Surg Endosc 32, 2781–2792 (2018). https://doi.org/10.1007/s00464-017-5979-x

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  • DOI: https://doi.org/10.1007/s00464-017-5979-x

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