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The impact of laparoscopy on emergency surgery for adhesional small bowel obstruction: prospective single centre cohort study

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Introduction: Laparoscopic adhesiolysis is being increasingly used to treat adhesional small bowel obstruction (ASBO) as it has been associated with reduced post-operative length of stay (LOS) and faster recovery. However, concerns regarding limited working space, iatrogenic bowel injury, and failure to relieve the obstruction have limited its uptake. This study reports our centre’s experience of adopting laparoscopy as the standard operative approach. 
 
Methods: A single centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; January 2015 to December 2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and in-hospital outcome data were compared between different surgical approaches. Linear regression analysis was performed for length of stay.

Results: A total of 299 cases were identified. Overall, 76.3% of cases were started laparoscopically and 52.2% completed successfully. Patients treated laparoscopically had lower P-POSSUM predicted mortality (median 2.1 [IQR 1.3-5.0] vs 5.7 [IQR 2.0-12.4], p=<0.001) and shorter post-operative LOS compared to open (median 4.2 days [IQR 2.5-8.2] vs 11.3 days [IQR 7.3-16.6], p=0.000). In-hospital mortality was lower in the laparoscopic group (2 vs 7 deaths, p=<0.001). In regression analysis laparoscopic surgery was found to have the strongest association with post-operative LOS (Β -8.51 [-13.87 – -3.16] p=0.002) compared to open surgery. 

Conclusion: Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is associated with reduced LOS with no impact on complications or mortality.
Original languageEnglish
Pages (from-to)255-262
Number of pages8
JournalThe Annals of The Royal College of Surgeons of England
Volume103
Issue number4
Early online date8 Mar 2021
DOIs
Publication statusPublished - 4 Apr 2021

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