TY - JOUR
T1 - Early postoperative small bowel obstruction
T2 - Open vs laparoscopic
AU - Goussous, Naeem
AU - Kemp, Kevin M.
AU - Bannon, Michael P.
AU - Kendrick, Michael L.
AU - Srvantstyan, Boris
AU - Khasawneh, Mohammad A.
AU - Zielinski, Martin D.
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background The window for safe reoperation in early postoperative (<6 weeks) small bowel obstruction (ESBO) is short and intimately dependent on elapsed time from the initial operation. Laparoscopic procedures create fewer inflammatory changes than open laparotomies. We hypothesize that it is safer to reoperate for ESBO after laparoscopic procedures than open. Methods Review of patients who underwent re-exploration for ESBO from 2003 to 2009 was performed. Based on the initial operation, patients were classified as "open" or "laparoscopic." The Revised Accordion Severity Grading System was used to define complications as minor (1 to 2) or severe (3 to 6). Results There were 189 patients identified (age 55 years, 48% male): 130 open and 59 laparoscopic. Adhesive disease was more common (65% vs 42%, P <.01), while strictures were less frequent (5% vs 14% P =.03), in the open group. The open group had a greater rate of malignancy, days to re-exploration, and severity of complications. There was no difference in the rates of minor complications, enterotomy, and mortality. ESBO after laparoscopic surgery was more commonly caused by a focal source (85% vs 63%). Eighty-three patients (64 open, 19 laparoscopic) underwent re-exploration at or beyond 14 days. Within this subgroup, there were more severe complications (25% vs 5%) after open procedures with equivalent mortality (4% vs 0%). Conclusions Laparoscopic approaches confer a lower rate of adhesive disease and severity of complications in early SBO as compared with open surgery even if performed after 2 weeks of index procedure.
AB - Background The window for safe reoperation in early postoperative (<6 weeks) small bowel obstruction (ESBO) is short and intimately dependent on elapsed time from the initial operation. Laparoscopic procedures create fewer inflammatory changes than open laparotomies. We hypothesize that it is safer to reoperate for ESBO after laparoscopic procedures than open. Methods Review of patients who underwent re-exploration for ESBO from 2003 to 2009 was performed. Based on the initial operation, patients were classified as "open" or "laparoscopic." The Revised Accordion Severity Grading System was used to define complications as minor (1 to 2) or severe (3 to 6). Results There were 189 patients identified (age 55 years, 48% male): 130 open and 59 laparoscopic. Adhesive disease was more common (65% vs 42%, P <.01), while strictures were less frequent (5% vs 14% P =.03), in the open group. The open group had a greater rate of malignancy, days to re-exploration, and severity of complications. There was no difference in the rates of minor complications, enterotomy, and mortality. ESBO after laparoscopic surgery was more commonly caused by a focal source (85% vs 63%). Eighty-three patients (64 open, 19 laparoscopic) underwent re-exploration at or beyond 14 days. Within this subgroup, there were more severe complications (25% vs 5%) after open procedures with equivalent mortality (4% vs 0%). Conclusions Laparoscopic approaches confer a lower rate of adhesive disease and severity of complications in early SBO as compared with open surgery even if performed after 2 weeks of index procedure.
KW - Keywords Small bowel obstruction
KW - Laparoscopic surgery
KW - Open surgery
UR - http://www.scopus.com/inward/record.url?scp=84922626516&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84922626516&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2014.07.012
DO - 10.1016/j.amjsurg.2014.07.012
M3 - Article
C2 - 25457244
AN - SCOPUS:84922626516
SN - 0002-9610
VL - 209
SP - 385
EP - 390
JO - American journal of surgery
JF - American journal of surgery
IS - 2
ER -