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Laparoscopic Treatment of Complex Small Bowel Obstruction: Is It Safe?

Department of Surgery, National Naval Medical Center, Bethesda, Maryland, Jonathan.pearl{at}med.navy.mil

Jeffrey M. Marks, MD

Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio

Jeffrey M. Hardacre, MD

Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio

Jeffrey L. Ponsky, MD

Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio

Conor P. Delaney, MD

Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio

Michael J. Rosen, MD

Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio

Laparoscopic treatment of small bowel obstruction has many reported advantages, yet it is infrequently performed. Criticisms include reduced working space, difficult abdominal access, and bowel injury. The experience with laparoscopic treatment of small bowel obstruction to determine its safety has been reviewed. Nineteen patients underwent laparoscopic treatment of small bowel obstruction. A cut-down technique was used for abdominal access and avoided manipulation of dilated bowel. The average number of prior operations was 1.4. The average size of maximally dilated bowel was 3.5 cm, including 6 patients whose diameter was greater than 4 cm. Laparoscopic treatment was successful in 16 patients; 3 patients required laparotomy. There were no complications from abdominal access and no iatrogenic bowel injuries. This series demonstrated that abdominal access and relief of bowel obstruction can be safely performed laparoscopically in patients with complex small bowel obstruction. Neither massively dilated bowel nor multiple previous abdominal operations precluded safe conduct of the operation laparoscopically.

Key Words: small bowel obstruction • laparoscopy

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