Laparoscopy for acute small-bowel obstruction secondary to adhesions.
J Laparoendosc Adv Surg Tech A
; 10(3): 155-9, 2000 Jun.
Article
em En
| MEDLINE
| ID: mdl-10883993
ABSTRACT
BACKGROUND AND PURPOSE:
Postoperative adhesions are the leading cause of small-bowel obstruction in developed countries. Several arguments suggest that laparoscopy may lead to fewer adhesions than does laparotomy. We report here the short-term results of laparoscopy in patients admitted on an emergency basis for acute small-bowel obstruction secondary to adhesions. PATIENTS ANDMETHODS:
This prospective trial included 134 consecutive patients 39 underwent emergency surgery, and 95 had laparoscopic adhesiolysis shortly after resolution of the obstruction with nasogastric suction. Of the previous operations for which the dates were known, 16% had taken place within 1 year of the obstruction and 33.5% within 5 years. In all, 27% of the patients had open laparoscopy, and 16% had conversions 7% after elective laparoscopy and 36% after emergency laparoscopy.RESULTS:
There were no operative deaths. One patient underwent a reoperation the following day for fistula after incomplete adhesiolysis attributable to multiple adhesions found during elective laparoscopy. If laparoscopy is considered to have failed when adhesiolysis was incomplete or conversion or reoperation was necessary, our success rate was 80% after elective laparoscopy and 59% after emergency laparoscopy.CONCLUSION:
Emergency situations in acute small-bowel obstruction combine several circumstances unfavorable for laparoscopy a limited work area and a distended and fragile small bowel. Laparoscopic adhesiolysis after the crisis has passed may produce better results, but only long-term follow-up can confirm the role of elective laparoscopy for this indication.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Laparoscopia
/
Obstrução Intestinal
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Laparoendosc Adv Surg Tech A
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
França