Feasibility of Laparoscopic Surgery in Patients with Postoperative Adhesive Small Bowel Obstruction

Abstract Purpose Laparoscopic surgery for abdominopelvic disease is minimally invasive and associated with mild adhesion formation, resulting in a low incidence of small bowel obstruction after surgery. Theoretically, laparoscopic surgery may be a reasonable treatment modality for postoperative small bowel obstruction. This study aimed to evaluate the safety and effectiveness of laparoscopic surgery in the treatment of postoperative adhesive small bowel obstruction. Methods This study included in 404 consecutive patients who underwent laparoscopic surgery for postoperative small bowel obstruction at Kitasato University Kitasato Institute Hospital, Tokyo, Japan, between 2012 and 2021. Results The median number of episodes of postoperative small bowel obstruction was 4 (range:1-26) times. The median duration of recurrent episodes of small bowel obstruction (hereinafter, duration of suffering) was 4 years (range:1-60). A transnasal decompression tube and ureteral stent were inserted before surgery in 34 (8.4%) and 14 (3.5%) patients, respectively. The median operation time and blood loss volume were 176 min (range:43-654) and 10 g (range:10-2335), respectively. Conversion to open surgery was required in 19 (4.5%) patients. The following surgical procedures were performed: laparoscopic adhesiolysis (n=341; 84.4%), laparoscopic adhesiolysis with partial resection of the small bowel (n=56; 13.9%), and stricture plasty and/or bypass (n=7; 1.7%). Postoperative complications occurred in 67 (16.8%) patients: paralytic ileus in 53 (13.1%) patients, small bowel injury in wight (1.9%) and postoperative bleeding in two (0.5%) patients. Operative mortality occurred in 1 (0.2%). Conclusions Laparoscopic surgery can be safely performed in patients with postoperative adhesive small bowel obstruction.