Bowel obstruction is a frequent indication for emergent surgery. Laparoscopic approach has been considered a relative contraindication due to the potential for bowel distension and risk of intestinal surgery. As experience in laparoscopic surgery has increased, diagnosis and treatmet of this entity can be accomplished laparoscopically.
METHODS: An unselected group of patients diagnosed of bowel obstruction by clinical signs and symptoms and radiological studies underwent a laparoscopic procedure due to failure of medical treatment. Operative findings, procedure performed, perioperative and postoperative course, early and late complications and conversion rate were all considered.
RESULTS: 167 patients met the inclusion criteria. The most common findings were adhesions, abdominal wall hernias, primary cancer, inflammatory bowel disease, internal hernias and diverticular disease. The average age was 62 years (range 21-98). Laparoscopy was diagnostic in 100% of cases, and in 92.5% the definite treatment was accomplished laparoscopically. The conversion rate was 7.8%, mostly secondary to massive distension, inability to completely run the bowel, intestinal necrosis or advanced cancer.We have observed that a minimum of 600 cc of CO2 must be insufflated to accomplish the laparoscopic. Complications included wound infection in 4.2%, delayed ileus in 4.8%, sepsis 2.9%, reobstruction 4.2%. Overal mortality was 2.4%
CONCLUSIONS: Laparoscopic surgery is an effective diagnostic tool in bowel obstruction, with the advantages of a minimally invasive procedure. It can be also valuable as a therapeutic option for this group of patients, although a careful approach and appropriate training is advisable
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