Abstracts
1997 Digestive Disease Week

Laparoscopic management of SBO: indications and outcome.

A Metzger, E Luque-de Leon, GG Tsiotos, RT Schlinkert*, MG Sarr. Department of Surgery, Mayo Clinic. Rochester, MN, and *Scottsdale, AZ.

AIM: To evaluate the feasibilty of laparoscopic treatment of patients with SBO. METHODS: Since 1991, 40 patients underwent laparoscopic treatment of SBO; 27 had confirmed SBO with acute complete (4), nonresolving partial (10) or recurrent partial (13) SBO; 7 had suspected SBO with a history and/or motility study suggestive of SBO; and 6 had an unclear diagnosis, with SBO in the differential. None had chronic abdominal or pelvic pain. Most (80%) had >= 1 prior abdominal operations. Pneumoperitoneum was created with an open technique. Only 3 trocars were used in most cases. Systematic inspection of the entire SB from ileocecal valve to ligament of Treitz was an essential part of the procedure. When direct inspection or resection of the SB was needed, a laparoscopically-assisted (L-A) approach was used. RESULTS: Adhesions, strictures, neoplasms, or other were the main findings in 27, 5, 2 and 2 patients respectively; no abnormalities were found in 4 patients. The operation was completed laparoscopically in 14 (35%) and with L-A procedures in 12 (30%); 14 (35%) required conversion to open celiotomy (OC), because of dense adhesions (precluding complete inspection or adhesiolysis), SB necrosis in setting of SBO, or neoplasia. Laparoscopy was most effective in patients with recurrent partial SBO as 11 of 13 (85%) did not need an OC. Three iatrogenic enterotomies were produced while "running" the bowel; 1 was repaired L-A and 2 after conversion to OC for other causes. There were 3 postop procedure-related complications (7%) (wound infection, intraabdominal abscess, ileus); one patient died from unrelated comorbidity on postop day 20. Patients treated laparoscopically or L-A had a shorter hospital stay than those converted to OC (4±0.6 vs 7±0.7 days, p<0.001). At median follow-up of 12 mo (range 2-56), 21 of 26 patients managed laparoscopically (81%) remain asymptomatic; of the 5 patients with persistent symptoms, no abnormality was found at laparoscopy in 3; these patients presumably have a motility disorder. SUMMARY: Laparoscopic treatment of SBO, especially recurrent partial SBO, can be effective, leads to shorter hospital stay, and has good long term results. CONCLUSION: A laparoscopic approach to treatment of SBO should be considered in selected patients.