The Role of Laparoscopy in the management of 448 Emergent Intestinal Obstruction

Song Liang, MD, PhD, Morris E Franklin Jr, MD, FACS, Jeffrey L Glass, MD, FACS

Texas Endosrugery Institute

Introduction: Both diagnostic and therapeutic laparoscopy had been applied as acceptable approaches to manage intestinal obstruction in the acute setting. This prospective study based on our practice was aimed at investigating the practicability and applicability of laparoscopic approaches in emergent management of both small and large bowel obstructions

Method: A prospective database was mined to identify a consecutive series of patients from April 1991 to May 2012, who underwent laparoscopy for emergently managing intestinal obstruction at the Texas Endosurgery Institute. All the perioperative information was processed by SSPS.

Results: Diagnostic laparoscopy was attempted to confirm the causes of all 448 bowel obstructions, subsequently the procedures of therapeutic laparoscopy including lysis of adhesion, repair of hernia, resection of diseased intestine, and creation of ostomy were successfully performed on 333 patients (74.3%). In 62 patients (13.8%), their laparoscopic procedures were converted to open ones for various reasons such as loss of operating space due to dilatation of bowel, accidental bowel perforation, uncontrollable bleeding, and bulky tumor. The mean blood loss during the procedures of therapeutic laparoscopy was estimated to 60 cc with standard deviation (SD) of 34.1, and operating time for entire procedures is 113.8 +/-34.3 minutes . Post-procedure mortality was calculated to be 1.7% and length of hospital stay was 10.4 days. Lastly linear regression showed a relation between ASA score and length of stay (p value 0.0001).

Conclusions: Both small and large intestinal obstruction can be effectively managed by laparoscopy regardless of the pathogenesis of obstructions. Diagnostic laparoscopy not only helps to establish definitive diagnosis but also contributes to the decision-making and road-mapping on how to operate on the disease entities that caused the obstructions. Furthermore with comparable OR time, and postoperative morbidity as well as mortality rates, therapeutic laparoscopy can be integrated into the emergent operations for surgically treating intestinal obstruction from various etiologies.

Session: Poster Presentation

Program Number: P572