Adhesive small bowel obstruction: predictive factors of laparoscopic failure.
Adhesive small bowel obstruction
Conversion to open
Feces sign
Laparoscopy
Laparotomy
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
27 Dec 2023
27 Dec 2023
Historique:
received:
09
08
2023
accepted:
01
12
2023
medline:
28
12
2023
pubmed:
28
12
2023
entrez:
27
12
2023
Statut:
aheadofprint
Résumé
The adoption of laparoscopy for the management of adhesive small bowel obstruction (ASBO) patients is debated. The laparoscopic approach has been associated with a considerable conversion-to-open rate. Nonetheless, reliable predictors of conversion are still unclear. The present study aimed to identify factors associated with conversion to open in ASBO patients who underwent laparoscopic surgery. Patients who underwent laparoscopic surgery for ASBO and were admitted to our unit between December 2014 and October 2022 were retrospectively evaluated. The patients were categorized into two groups: patients who underwent complete laparoscopy approach (Group 1) and patients converted to open technique (Group 2). Demographic, clinical, and radiological features, intraoperative findings, and postoperative outcomes were compared. A total of 168 patients were enrolled: 100 patients (59.5%) were included in Group 1, and 68 patients (40.5%) were included in Group 2. The rate of ischemia (p = 0.023), surgical complications (p = 0.001), operative time (p < 0.0001), days of nasogastric tube maintenance (p < 0.0001), time to canalization (p < 0.0001), and length of hospital stay (p < 0.0001) were significantly higher in Group 2 than Group 1. Following univariate analysis, the presence of feces signs (p = 0.044) and high mean radiodensity of intraperitoneal free fluid (p = 0.031) were significantly associated with Group 2 compared with Group 1. Following multivariate analysis, the feces sign was a significant predictive factor of conversion (OR 1.965 [IC 95%]; p = 0.046). Laparoscopic treatment is a safe and effective approach in patients affected by ASBO. The feces sign may be a predictive factor of conversion and could guide the surgeon in selecting the appropriate management of patients affected by ASBO.
Identifiants
pubmed: 38151681
doi: 10.1007/s13304-023-01725-y
pii: 10.1007/s13304-023-01725-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A (2015) Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc 29(9):2525–2532
doi: 10.1007/s00464-014-4015-7
pubmed: 25480627
Azagury D, Liu RC, Morgan A, Spain DA (2015) Small bowel obstruction: a practical step-by-step evidence-based approach to evaluation, decision making, and management. J Trauma Acute Care Surg 79(4):661–668
doi: 10.1097/TA.0000000000000824
pubmed: 26402543
Scott FI, Osterman MT, Mahmoud NN, Lewis JD (2012) Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007. Am J Surg 204(3):315–320
doi: 10.1016/j.amjsurg.2011.10.023
pubmed: 22575399
pmcid: 3419344
Sallinen V, Di Saverio S, Haukijärvi E, Juusela R, Wikström H, Koivukangas V, Catena F, Enholm B, Birindelli A, Leppäniemi A, Mentula P (2019) Laparoscopic versus open adhesiolysis for adhesive small bowel obstruction (LASSO): an international, multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol 4(4):278–286
doi: 10.1016/S2468-1253(19)30016-0
pubmed: 30765264
Di Saverio S, Birindelli A, Broek RT, Davies JR, Mandrioli M, Sallinen V (2018) Laparoscopic adhesiolysis: not for all patients, not for all surgeons, not in all centres. Updates Surg 70(4):557–561
doi: 10.1007/s13304-018-0534-4
pubmed: 29767333
pmcid: 6244716
Kelly KN, Iannuzzi JC, Rickles AS, Garimella V, Monson JR, Fleming FJ (2014) Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc 28(1):65–73
doi: 10.1007/s00464-013-3162-6
pubmed: 24002917
Hackenberg T, Mentula P, Leppäniemi A, Sallinen V (2017) Laparoscopic versus open surgery for acute adhesive small-bowel obstruction: a propensity score-matched analysis. Scand J Surg 106(1):28–33
doi: 10.1177/1457496916641341
pubmed: 27048680
Yao S, Tanaka E, Matsui Y, Ikeda A, Murakami T, Okumoto T, Harada T (2017) Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity score-matched analysis. Surg Endosc 31(12):5348–5355
doi: 10.1007/s00464-017-5615-9
pubmed: 28593412
Lin H, Li J, Xie Z, Zhang W, Lv X (2016) Laparoscopic versus open adhesiolysis for small bowel obstruction: a single-center retrospective case-control study. Surg Laparosc Endosc Percutan Tech 26(3):244–247
doi: 10.1097/SLE.0000000000000259
pubmed: 27077222
Wiggins T, Markar SR, Harris A (2015) Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis. Surg Endosc 29(12):3432–3442
doi: 10.1007/s00464-015-4114-0
pubmed: 25840892
Krielen P, Di Saverio S, Ten Broek R, Renzi C, Zago M, Popivanov G, Ruscelli P, Marzaioli R, Chiarugi M, Cirocchi R (2020) Laparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes. J Trauma Acute Care Surg 88(6):866–874
doi: 10.1097/TA.0000000000002684
pubmed: 32195994
Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V (2000) Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Surg Endosc 14(5):478–483
doi: 10.1007/s004640000104
pubmed: 10858476
Levard H, Boudet MJ, Msika S et al (2001) Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 71(11):641–646
doi: 10.1046/j.0004-8682.2001.02222.x
pubmed: 11736822
Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90(9):1147–1151
doi: 10.1002/bjs.4177
pubmed: 12945085
Chosidow D, Johanet H, Montariol T, Kielt R, Manceau C, Marmuse JP, Benhamou G (2000) Laparoscopy for acute small-bowel obstruction secondary to adhesions. J Laparoendosc Adv Surg Tech A 10(3):155–159
doi: 10.1089/lap.2000.10.155
pubmed: 10883993
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M (2004) Frequency and relevance of the “small-bowel feces” sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 183(5):1361–1366
doi: 10.2214/ajr.183.5.1831361
pubmed: 15505304
Kouniavsky G, Gotler J, Harris R, Gulman M, Sapoznikov S, Mavor E, Lin G (2023) The “Feces Sign” increases conversion to open exploration during laparoscopic surgery for small bowel obstruction. Am Surg 89(3):473–475
doi: 10.1177/0003134820973385
pubmed: 35448930
Sheedy SP, Earnest F, Fletcher JG, Fidler JL, Hoskin TL (2006) CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 241(3):729–736
doi: 10.1148/radiol.2413050965
pubmed: 17114622
Delabrousse E, Lubrano J, Jehl J, Morati P, Rouget C, Mantion GA, Kastler BA (2009) Small-bowel obstruction from adhesive bands and matted adhesions: CT differentiation. AJR Am J Roentgenol 192(3):693–697
doi: 10.2214/AJR.08.1550
pubmed: 19234265
Millet I, Ruyer A, Alili C, Curros Doyon F, Molinari N, Pages E, Zins M, Taourel P (2014) Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology 273(2):425–432
doi: 10.1148/radiol.14132872
pubmed: 24991990
Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, Velmahos GC, Sartelli M, Fraga GP, Kelly MD, Moore FA, Peitzman AB, Leppaniemi A, Moore EE, Jeekel J, Kluger Y, Sugrue M, Balogh ZJ, Bendinelli C, Civil I, Coimbra R, De Moya M, Ferrada P, Inaba K, Ivatury R, Latifi R, Kashuk JL, Kirkpatrick AW, Maier R, Rizoli S, Sakakushev B, Scalea T, Søreide K, Weber D, Wani I, Abu-Zidan FM, De’Angelis N, Piscioneri F, Galante JM, Catena F, van Goor H (2018) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 13:24
doi: 10.1186/s13017-018-0185-2
pubmed: 29946347
pmcid: 6006983
Chin RL, Lima DL, Pereira X, Romero-Velez G, Friedmann P, Dawodu G, Sterbenz K, Yamada J, Sreeramoju P, Smith V, Malcher F (2023) Assessing outcomes in laparoscopic vs open surgical management of adhesive small bowel obstruction. Surg Endosc 37(2):1376–1383
doi: 10.1007/s00464-022-09314-7
pubmed: 35587296
Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK (2016) A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg 212(1):138–150
doi: 10.1016/j.amjsurg.2016.01.030
pubmed: 27162071
Li MZ, Lian L, Xiao LB, Wu WH, He YL, Song XM (2012) Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 204(5):779–786
doi: 10.1016/j.amjsurg.2012.03.005
pubmed: 22794708
Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F (2010) Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev 2010(2):CD007511
pubmed: 20166096
pmcid: 7202250
Darbyshire AR, Kostakis I, Pucher PH, Toh S, Mercer SJ (2021) The impact of laparoscopy on emergency surgery for adhesional small bowel obstruction: prospective single centre cohort study. Ann R Coll Surg Engl 103(4):255–262
doi: 10.1308/rcsann.2020.7079
pubmed: 33682461
pmcid: 10334926
Sebastian-Valverde E, Téllez C, Burdío F, Poves I, Grande L (2022) Need for conversion reduces the benefits of laparoscopic approach for adhesive small bowel obstruction. A propensity-score matching analysis. J Gastrointest Surg 26(10):2218–2220
doi: 10.1007/s11605-022-05322-z
pubmed: 35469037
Al-Mulhim AA (2000) Laparoscopic management of acute small bowel obstruction. Experience from a Saudi teaching hospital. Surg Endosc 14(2):157–160
doi: 10.1007/s004649900090
pubmed: 10656951
Strickland P, Lourie DJ, Suddleson EA, Blitz JB, Stain SC (1999) Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 13(7):695–698
doi: 10.1007/s004649901075
pubmed: 10384077
Navez B, Arimont JM, Guiot P (1998) Laparoscopic approach in acute small bowel obstruction. A review of 68 patients. Hepatogastroenterology 45(24):2146–2150
pubmed: 9951882
Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S (2005) Laparoscopic management of acute small bowel obstruction. Surg Endosc 19(4):464–467
doi: 10.1007/s00464-004-9038-z
pubmed: 15959710
Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D (2010) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24(4):792–797
doi: 10.1007/s00464-009-0658-1
pubmed: 19730954
Ghosheh B, Salameh JR (2007) Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 21(11):1945–1949
doi: 10.1007/s00464-007-9575-3
pubmed: 17879114
Denkler CS, Rodgers A, Emery EL, Collins DT, Liu C, Fennessy T, Dort JM (2020) Clinical factors associated with success in applying laparoscopy in the management of small bowel obstruction at a tertiary care center. Surg Endosc 34(7):3021–3026
doi: 10.1007/s00464-019-07098-x
pubmed: 31482347