Back to Annual Meeting Posters

Purpose: Small bowel resection is a commonly performed surgical procedure for both benign and malignant disease. The advantages of laparoscopic versus open surgery are well established in the literature; however, a majority of small bowel resections are performed using an open technique. To date, no study has reviewed the ACS-NSQIP database to determine the utilization of laparoscopy for small bowel resection nationally. The purpose of this study is to determine the incidence of laparoscopic small bowel resection and to compare the safety of a minimally invasive technique to an open technique.
Methods: A retrospective, cohort study was performed comparing patients undergoing a minimally invasive small bowel resection to an open technique. Patients were identified utilizing a CPT code driven search of the ACS-NSQIP database between 2007 and 2011. Demographic characteristics and postoperative complications were evaluated between the two groups. Univariate analysis was performed with significance defined as a p-value ≤ 0.05.
Results: 19,344 patients underwent a small bowel resection. Of these patients, 1,719 (9%) underwent a laparoscopic small bowel resection and 17,625 (91%) underwent an open resection. The mean age of patients in the minimally invasive group was 57.5 compared to 62.7 years in the open group. A majority of patients undergoing small bowel resection were female (54%) and of the patients who underwent laparoscopic small bowel resection, 54% were female. The mean body mass index in the minimally invasive versus open groups was 27.3 and 27.4, respectively. There was a statistically significant lower rate of complications in the minimally invasive group (p=0.001). In the minimally invasive group, the risk ratio for a postoperative wound infection compared to the open approach was 0.31 (0.24-0.40), for postoperative sepsis was 0.39 (0.28-0.53), for postoperative septic shock was 0.24 (0.10-0.37), for postoperative pneumonia was 0.36 (0.26-0.50), for postoperative myocardial infarction was 0.43 (0.22-0.8) and for postoperative DVT requiring therapy was 0.31 (0.16-0.57). The in-hospital 30-day mortality rate for a minimally invasive resection was 1.7% compared to 6.4% for an open resection (p=0.001).
Conclusion: Despite the advantages of minimally invasive surgery, a large majority of operations for the resection of small bowel are performed via a traditional open approach. This discrepancy is likely not explained entirely by patient factors. The data suggest an opportunity for improved patient outcomes and improved mortality rates with widespread adoption of minimally invasive approaches to small bowel resection.