Many general surgical procedures are being performed increasingly via laparoscopy. The short bowel syndrome (SBS) is a potential postoperative complication after intraabdominal procedures. Intestinal ischemia secondary to pneumoperitoneum has been reported after a variety of laparoscopic procedures. Our aim was to evaluate potential mechanisms of SBS following laparoscopic procedures.
The records of 85 adult patients developing SBS as a postoperative complication were reviewed. 75 patients had open procedures and ten patients laparoscopic. Colectomy 26 (35%), hysterectomy 8 (11%) appendectomy 7 (9%) ileoanal 6 (8%) and gastric bypass 5 (7%) were the most common open procedures. SBS followed laparoscopic cholecystectomy (n=5), gastric bypass (n=3), lysis of adhesions (n=1) and ileal pouch-anal anastomosis (n=1). The mechanisms of SBS were similar in the open and laparoscopic groups (adhesions 48% vs 40%, volvulus 24% vs 20%, and ischemia 28% vs 40%). Of the 5 cholecystectomy patients, 2 developed SMV thrombosis in the early postoperative period, presumably secondary to pneumoperitoneum. Two of the 3 bariatric procedures had internal hernias and volvulus. The ileoanal patient developed SMV thrombosis. The laparoscopic lysis of adhesions was complicated by perforation and repeated operations for obstruction and sepsis. In the laparoscopic group small intestine remnant length was 120cm (n=2). Four patients were weaned off TPN, 2 underwent intestinal transplant, one died from postoperative complications and three remain TPN dependent.
SBS is an increasingly recognized complication of laparoscopic procedures. The mechanisms of bowel injury are similar to those of open procedures with only 20% related to the laparoscopic technique.
Program Number: P146