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Background:
The application of laparoscopy in acute care surgery continues to expand. Adhesive small bowel obstruction has traditionally been managed via an open approach although appropriately selected patients may benefit from laparoscopy.
Objective:
The objective of this study is was to compare short-term post-operative outcomes in patients with adhesive small bowel obstruction (SBO) treated laparoscopically versus with laparotomy.
Methods:
Using the (2005-2010) ACS NSQIP Participant Use Files, patients with a post-operative diagnosis of adhesive SBO were selected for inclusion in this study. Patients were excluded if they had a bowel resection or other concomitant procedures. Data on cases converted to laparotomy was not available. Both univariate analyses and multivariate logistic regression were performed to compare the open and laparoscopic groups for 30-day morbidity and mortality outcomes.
Results:
4,760 patients with adhesive SBO were identified in the dataset: 3,847 (80.1%) treated with laparotomy, and 919 (19.3%) via a laparoscopic approach. Mean operative time was similar in both groups. There were a total of 275 (7.2%) wound infections in the open group compared to 6 (0.7%) in the laparoscopic group corresponding to an OR (95% CI, P-value) of 11.7 (5.30-32.35, P<0.001). The mortality and overall complications were 87 (2.3%) and 877 (22.8%) in the open group compared to 7 (0.6%) and 91 (9.9%), with respective unadjusted OR 3.02 (1.40-7.76, P=0.003) and 2.70 (2.14-3.42, P<0.001). Using our multivariate model, the adjusted OR for overall complications was 2.27 (1.80-2.87, P<0.001) favoring the laparoscopic group. The mean post-operative length of stay was 8.4 days after the open approach, compared to 3.8 after the laparoscopic approach (P<0.001).
Conclusion:
In patients where laparoscopy was feasible, the laparoscopic approach resulted in significantly fewer complications and shorter length of stay. This should be interpreted within the context of a retrospective study with inherent selection bias, inability to control for all patient characteristics, and the inability to identify patients who required conversion from the laparoscopic approach. Further work is needed to better define appropriate patient selection criteria to guide the broader application of laparoscopy in the treatment of SBO.
Table of 30-day Post-operative Complications

Complication	Open N (%)	Laparoscopic N (%)	Unadjusted OR (95% CI)	P-value
Wound	275 (7.2)	6 (0.7)	11.7 (5.30 - 32.35)	P<0.001
Infectious	459 (12.0)	53 (5.8)	2.2 (1.65 - 3.03)	P<0.001
Respiratory	155 (4.0)	10 (1.1)	3.8 (2.01 - 8.16)	P<0.001
Thromboembolic	72 (1.9)	7 (0.76)	2.49 (1.14 - 6.23)	P=0.018
Renal	33 (0.9)	0 (0.0)	N/A	P=0.005
Neurologic	15 (0.4)	3 (0.3)	1.20 (0.34 - 6.46)	P=0.778
Cardiac	40 (1.0)	6 (0.7)	1.60 (0.67 - 4.64)	P=0.279
Bleeding	85 (2.2)	6 (0.7)	3.44 (1.51 - 9.68)	P=0.002
Mortality	87 (2.3)	7 (0.6)	3.02 (1.40, 7.76)	P=0.0033
Major Complications	643 (16.7)	81 (8.8)	2.08 (1.62, 2.69)	P<0.001
Overall Complications	877 (22.8)	91 (9.9)	2.70 (2.14, 3.42)	P<0.001