Kenichi Mizunuma, MD1, Yusuke Watanabe, MD1, Fumitaka Nakamura, MD1, Nobuichi Kashimura, MD1, Satoshi Hirano, MD2. 1Department of General Surgery, Teine Keijinkai Hospital, 2Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine
Back ground: While laparoscopic management have been increasingly used for small bowel obstruction (SBO), the clinical outcomes and benefits of applying laparoscopic surgery to strangulated SBO are limited. With growing experience of laparoscopy for SBO, the laparoscopic treatment for strangulated SBO has been introduced gradually into our institute. The objective of this study was to report our experience with laparoscopic management of strangulated SBO and describe our techniques.
Methods: Electronic medical records of patients with strangulated SBO undergoing initial laparoscopic treatment between January 2010 and March 2016 were reviewed. Medical records were reviewed to obtain data on demographics, intraoperative findings, 30-day morbidity and mortality, postoperative length of stay, and readmission. With growing experience, the definitive indication for laparoscopy was all suspected strangulated SBO regardless of the type of previous laparotomy, case difficulty, or predicted working space. The cases requiring a small incision (<5cm) for a segmental bowel resection were considered laparoscopic treatment and not counted as a conversion. Data are expressed as n (%) and median [interquartile range]
Results: Of 199 consecutive patients with SBO who required emergency surgery at our institute, 92patients with strangulated SBO were included for this study (46% male, median age 74[55; 94]). Of 38 patients that underwent initial laparoscopic management (34% male, median age 73 [54; 91]), the pneumoperitoneum was successfully created in all patients. The obstructions were relieved using various laparoscopic techniques without bowel resections in 31(82%) patients, and 7(19%) patients required a segmental bowel resection through a small incision after laparoscopic reliefs. The conversion rate to open was 19% (9 patients). The reasons for conversion were the lack of working space [4 (9%)], intraoperative bowel perforation [3 (6%)], unknown origin [1 (2%)] and dense bowel necrosis [1 (2%)]. One or more complications occurred in 9 patients (17%), including surgical site infection [1 (2%)], paralytic ileus [5 (10%)] and aspiration pneumonia [3 (6%)]. The mortality was 4% following the death of 2 very elderly patients (>85 years old): presented a severe aspiration pneumonia. The postoperative length of stay was 7[4; 11] days and there were no readmissions.
Conclusions: Initial laparoscopic management seems to be a feasible approach to patients with strangulated SBO in most cases. This approach could target the location of incision when requiring a bowel resection and may result in lower morbidity rate and a shorter hospitalization.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87035
Program Number: P053
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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