CONVERSION FROM LAPAROSCOPY TO LAPAROTOMY IN PATIENTS UNDERGOING SURGERY FOR SMALL BOWEL OBSTRUCTION: DOES PRIOR HISTORY OF SBO OR PREVIOUS ABDOMINAL SURGERY MATTER?

Remealle A How, MD¹, Valerie G Sams, MD¹, Christopher Corkins, MD¹, John C Graybill, MD¹, James Aden¹, Martin D Zielinski, MD², Daniel C Cullinane, MD³, Kenji Inaba, MD⁴, Daniel D Yeh, MD⁵, Salina Wydo, MD⁶, David S Turay, MD⁷, Andrea Pakula, MD, MPH⁸, Therese M Duane, MD, MPH⁹, Jill Watras, MD¹⁰, Kenneth A Widom, MD¹¹, John Cull, MD¹², Carlos J Rodriguez, DO, MBA¹³, Eric A Toschlog, MD¹⁴, Mohamed D Ray-Zack, MD², Matthew C Hernandez, MD², Asad Choudhry, MD², Richard Lesperance, MD¹. ¹San Antonio Uniformed Services Health Education Consortium (SAMMC), ²Mayo Clinic, ³Marshfield Clinic, ⁴University of Southern California, ⁵University of Miami, ⁶Cooper University Hospital, ⁷Loma Linda University, ⁸Kern Medical Center, ⁹John Peter Smith Hospital, ¹⁰Inova Fairfax Hospital, ¹¹Geisinger Medical Center, ¹²Greenville Memorial Hospital, ¹³Walter Reed National Military Medical Center, ¹⁴East Carolina University

Introduction: Laparoscopic adhesiolysis can be used for small bowel obstruction (SBO); however, conversion to laparotomy is frequent. In this study, we aimed to determine whether patient factors such as prior SBO or abdominal surgery were associated with an increased likelihood of conversion from laparoscopy (LS) to laparotomy (LT) in patients with SBO.

Methods and Procedures: We performed a post-hoc analysis of the EAST SBO database and included patients who initially underwent a laparoscopic approach. Patient history, admission physiology, laboratory data, and operative details were reviewed and compared between patients whose operations remained LS and those whose operations converted to LT. Descriptive statistics were calculated, and comparisons between groups were performed using Chi-squared test, Fisher’s exact test, and t test.

Results: Of the SBO patients (n=1322), 464 patients required surgery (35%). LS was initially attempted in 100 cases (21%). Of those, 56% required LT. Between groups, there were no differences in admission physiology or laboratory values. The rates of prior SBO admission or abdominal surgery were not significantly different between groups (p-values >0.05; Fig.1). More LT patients required small bowel resections (59% vs. 14%, p<0.001), anastomoses (54% vs. 14%, p<0.001), and had operative findings of perforation (9% vs. 0%, p=0.014) compared to LS patients. There were more nontherapeutic explorations in the LS group (p-value=0.04; Fig.2).

Conclusion: More than half of patients undergoing laparoscopy for SBO require conversion to laparotomy. No pre-operative patient factors, including prior hospitalization for SBO or previous abdominal surgery, were predictive of increased likelihood of conversion. Approach to a successful therapeutic laparoscopic intervention for small bowel adhesiolysis may not depend on the patient’s pre-operative history but more on intraoperative findings.