Article ; Online: Adhesive small bowel obstruction: predictive factors of laparoscopic failure.
2023 Volume 76, Issue 2, Page(s) 705–712
Abstract: 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 ... ...
| Abstract | 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. |
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| MeSH term(s) | Humans ; Tissue Adhesions/complications ; Tissue Adhesions/surgery ; Retrospective Studies ; Postoperative Complications/epidemiology ; Postoperative Complications/surgery ; Intestinal Obstruction/diagnostic imaging ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Laparoscopy/methods ; Treatment Outcome |
| Language | English |
| Publishing date | 2023-12-27 |
| Publishing country | Italy |
| Document type | Journal Article |
| ZDB-ID | 2572692-4 |
| ISSN | 2038-3312 ; 2038-131X |
| ISSN (online) | 2038-3312 |
| ISSN | 2038-131X |
| DOI | 10.1007/s13304-023-01725-y |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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