Therapeutic method and outcomes of using an access port device in laparoscopic surgery for small bowel obstruction

Ryosuke Nakata, Masaki Koizumi, Hideyuki Hagiwara, Naoto Chihara, Yuji Kurihara, Hideyuki Suzuki, Nobuhiko Taniai

Abstract


The use of laparoscopic surgery has spread at an accelerating rate due to its minimally invasive nature and the early rehabilitation that it affords. Whether laparoscopic surgery is feasible for small bowel obstruction (SBO), however, remains controversial. This retrospective study presents our experiences in the laparoscopic treatment of SBO to assess the feasibility, efficacy, and clinical outcomes in comparison with open surgery and to present the author’s surgical methods regarding the use of an access port device. From April 2014 to March 2015, 36 patients who were admitted to our department for SBO underwent surgical treatment. The operating surgeon attempted to detect a transitional point between the distended and collapsed bowel with preoperative computed tomography and then decided whether to perform laparoscopic surgery (LS; n=19) or open surgery (OS; n=17). Our laparoscopic surgical technique for SBO used an access port device and a small umbilical incision of 1.5 - 2.5 cm.  The background information of the patients and the postoperative outcomes were collected and subjected to a statistical analysis. Postoperative adhesions were the cause of the obstruction in 23 patients. Incarcerated inguinal and internal hernias were identified in 6 and 4 cases, respectively, and a tumor, intussusception and volvulus of the small intestine were identified in one case each. Three patients (15.8%) of the LS group were converted to laparotomy due to dense adhesion in one case and adhesion below the umbilicus in two cases. Six patients required segmental resection through the access device at the umbilicus. No statistically significant differences were found between LS and OS in the operative time (LS vs. OS; 85.3 min vs. 88.2 min, p=0.8570), postoperative complication rate (5.26% vs. 5.88%, p=0.9355), or the postoperative hospital stay (10.3 days vs. 15.9 days, p= 0.3524). There was a significant difference in the mean timing of oral re-intake after surgery and the amount of intraoperative blood loss (2.5 days vs. 4.5 days p<0.05, 3.8 g vs. 92.9 g p<0.05, respectively). In conclusion, our results indicate that LS with an access port device was suitable for the treatment of SBO in most patients, and that it is useful both as a diagnostic tool and as a therapeutic surgical approach.

 


Keywords


small bowel obstruction, laparoscopy, acute abdomen.

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