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OBJECTIVE: The window for safe re-operation in early post-operative (<6 weeks) small bowel obstruction (SBO) is short and intimately dependent on elapsed time from the initial operation. Laparoscopic procedures create fewer inflammatory changes than open laparotomies. We hypothesize that it is safer to re-operate for early SBO after laparoscopic procedures than open.
METHODS: Review of patients who underwent exploration for early post-operative SBO from 2003 to 2009 at a tertiary referral center. Based on the initial operation, patients were classified as ‘open' or ‘laparoscopic'. The Revised Accordion Severity Grading System was used to define complications as minor (1-2) or severe (3-6). P <0.05 was considered significant.
RESULTS: There were 189 patients (age 55 years, 48% male); 130 open and 59 laparoscopic. Adhesive disease was the most common cause of early SBO with the open group having the greatest rate (tables 1 and 2). The open group also had a greater rate of malignancy, days to re-operation, severity of complications, length of stay after re-operation (LOS) and persistent SBO at 6 weeks. There was no difference in the rates of minor complications, enterotomy, strangulation, re-reoperation, enterocutaneous fistula and mortality. 25% of the laparoscopic procedures were successfully completed laparoscopically at the reoperation and were more commonly caused by a focal source. 82 patients (63 open, 19 laparoscopic) underwent reexploration ≥ 14 days. Within this subgroup, there were more severe complications (25% vs 5%) after open procedures with equivalent mortality (4% vs 0%).
CONCLUSION: Initial laparoscopic approaches confer a lower rate of adhesive disease and severity of complications compared to open when operating for early post-operative SBO. Reoperation should be undertaken prior to 14 days, particularly after open procedures, as the complication severity continues to increase as time elapses from the date of initial operative intervention.
Causes for early post-operative SBO

Early post-op SBO Cause	Open n=130	Lap n=59	P
Adhesive	65%	42%	<0.01
External hernia	16%	27%	0.08
Internal hernia	8%	10%	0.57
Stricture	5%	14%	0.03
Volvulus	5%	7%	0.54
Malignant	1%	0%	0.34

Features of patients undergoing re-exploration

Features	Open n=130	Lap n=59	P
Active malignancy	42%	12%	<0.01
Days to reoperation	13	10	0.02
Severe complications	24%	10%	0.03
Minor complications	18%	23%	0.40
Re-reoperation	6%	7%	0.87
Mortality	5%	0%	0.09
Days after reoperation	10	9	0.02
Persistent SBO at 6 weeks	8%	0%	0.03
Focal cause of obstruction	63%	85%	<0.01
Strangulation obstruction	2%	7%	0.21
EC Fistula	2%	0%	0.24
Enterotomy	7%	12%	0.44