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THE USE OF LAPAROSCOPY IN THE SURGICAL MANAGEMENT OF SMALL BOWEL OBSTRUCTION

Catherine Denkler, MD, Erica Emery, MS, Devon Collins, MPH, Chang Liu, Tracy Fennessy, MD, Ashley Rodgers, Jonathan Dort, MD, FACS. Inova Fairfax Medical Campus

Introduction: The objective of our study was to determine clinical factors associated with success of laparoscopy in managing small bowel obstruction (SBO).  The use of laparoscopy in the management of SBO has been shown to be a safe alternative to laparotomy with studies demonstrating reduced morbidity, mortality, postoperative length of stay, and overall decreased complications with laparoscopy.  Nationally the use of laparoscopy in the management of SBO has not been fully adapted into general practice.  Many studies look at laparoscopy only in the setting of SBO secondary to adhesions.

Methods and Procedures: A retrospective study was conducted identifying all patients who were admitted to a large tertiary academic center with a diagnosis of SBO from 2014-2016.  The operative cases were grouped by method of surgical intervention: laparoscopy, laparoscopy converted to open, or laparotomy.  Clinical data included: gender, age, body mass index (BMI), presence of medical co-morbidities, smoking history, duration of obstruction prior to surgical intervention, presence of transition point on imaging, total number of prior abdominal surgeries (laparoscopic and open), etiology of SBO, number of adhesive bands (single versus multiple), return of bowel function prior to discharge, and need for additional procedures related to SBO during the same admission.  The primary outcome was successful laparoscopic procedure in the management of SBO, defined as resolution of SBO and no conversion from laparoscopic to open procedures.  Student’s t-test and Pearson’s x2 test were used to assess the association between each factor and the primary outcome. 

Results: A total of 227 adult patients admitted with a diagnosis of SBO received operative intervention. There were 40 successful laparoscopic cases, 36 failed laparoscopic cases (laparoscopic converted to open or no resolution of SBO), and 151 open cases.  With the exception of an association between success and BMI, our results demonstrated no other clinical or demographic differences among the successful laparoscopic group and the failed laparoscopic group.

Conclusions: Laparoscopy is effective in treating SBO due to various etiologies including single band adhesions, multiple adhesions, hernias, and masses.  Other than BMI, there was no single predictor of success or failure with laparoscopy.  Therefore, we conclude, that perhaps all patients requiring operative treatment for SBO deserve consideration for a diagnostic laparoscopy.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88086

Program Number: P061

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

60

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