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

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.