[Laparoscopic treatment of mechanical small bowel obstruction]

ABSTRACT

A history of abdominal surgery have long been considered a contraindication to laparoscopy. There was a reluctance to advocate the use of laparoscopy in mechanical bowel obstruction due to technical difficulties related to a distended small intestine, and a small work space. To report the results of laparoscopic treatment of small bowel mechanical obstruction and to study the factors for conversion to laparotomy. Our study is retrospective, having compiled 32 patients between January 2001 and December 2009. The average age was 35 years [20-54]. There were 17 men and 15 women. History of laparotomies were noted in 27 patients. Were excluded from this study patients with strangulated hernia or eventration. An analysis was conducted to determine the conversion factors to laparotomy. The flanges or postoperative adhesions were responsible for 27 of the 32 intestinal obstructions [84%]. In 24 cases there was a single flange or localized adhesions treated by simple section successfully in 18 patients [56% of cases]. A conversion was performed in 14 cases [44%]. The median time to recovery of intestinal transit was shorter after laparoscopic surgery completely after conversion [1.5 vs. 2.5 days, p = 0.004]. Similarly, the median length of postoperative stay was shorter in the absence of conversion [2.4 vs 7, p <0.001]. Statistical analysis identified four factors related to conversion, which are the presence of peritoneal signs, the number of brackets > 1, and the need for a bowel resection. Laparoscopy is an option for the treatment of mechanical bowel obstruction when performed in selected patients. His best indication could be the occlusion of single flange. This alternative to laparotomy could reduce adhesion formation and potentially reduce future episodes of obstruction