The Predictors of the Success Or Failure of Laparoscopic Surgery for the Management of Small Bowel Obstruction

Sang Hyun Kim, MD, Yong Ho Kim, MD, Sun Jin Park, MD, Sung Il Choi, MD

Department of Surgery, School of Medicine, Kyung Hee University

INTRODUCTION Laparoscopy is used increasingly for the management of small bowel obstruction, but the pooled data showed that conversion from laparoscopy to open surgery came to 1/3 of cases. Preoperative knowledge of factors that prevent successful laparoscopy could help in the decision to operate laparoscopically or openly. In this study, we tried to identify such factors by comparing the patients successfully treated with laparoscopy and those who needed conversion to open surgery.

METHODS AND PROCEDURES From June 2006 to March 2010, 30 patients underwent laparoscopic surgery for SBO at the Department of Surgery, Kyung Hee University Medical Center. The patients treated by laparoscopy were compared with those treated by laparotomy in terms of the differences in the preoperative laboratory findings, vital signs, previous abdominal surgery, duration of illness, bowel diameter on abdomen plain film and location of the transition zone on computerized tomography to identify the predictors of success or failure of laparoscopic surgery.

RESULTS Of the 30 cases, 22 cases were in the laparoscopic successful group (73.3%) and 8 cases were in the conversion group (26.7%). The causes of conversion to open surgery were severe bowel distension (2 cases), severe adhesion (2 cases), no visible cause of obstruction (1 case), iatrogenic bowel injury (1 case), bowel ischemia and perforation (1 case) and hemodynamic instability (1 case). There were no significant differences in the preoperative WBC count, CRP, pulse rate, number of past abdominal surgeries, duration of illness, bowel diameter on plain abdominal film and obstruction site between the successful group and conversion group. But Patients with preoperative high fever (>38Centigrade) in conversion group (25%) were significantly more than successful group (25% vs. 0%, p=0.02). Patients with previous appendectomy tended to be less in the successful group than in the conversion group (9.1% vs. 37.5%, p=0.07) and patients with previous gynecologic surgery tended to be more in the successful group than in the conversion group (50% vs. 12.5%, p=0.06).

CONCLUSION There were no pre-operative predictive factors for successful laparoscopy, except for factors such as afebrility and previous gynecological surgery. Nevertheless, larger, randomized prospective trials will be needed to determine the predictors of success or failure of laparoscopic surgery.

Session: Poster Presentation

Program Number: P528

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