Prospective Study Evaluating Laparoscopic Management of Adhesive Intestinal Obstruction
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- Category: Vol. 85, December 2017
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Prospective Study Evaluating Laparoscopic Management of Adhesive Intestinal Obstruction, AHMED SALAH SHALABY and MOHAMED MOSTAFA EL-SHEIKH
Abstract
Background: The development of adhesions leading to small bowel obstruction (SBO) has been universally recognized by surgeons ever since abdominal operations have been performed. Laparotomy to treat adhesive SBO seems a paradox as laparotomy is the most common cause of adhesive SBO currently.
Aim: The aim is to evaluate laparoscopic adhesiolysis in the management of adhesive intestinal obstruction as regard feasibility, post-operative pain and hospital stay.
Patient and Methods: This study was carried out on 14 patients, 18-53 years, presented with signs and symptoms of intestinal obstruction with previous abdominal surgical history. Patients were initially given supportive treatment in the form of insertion of nasogastric tube for decompression, Urinary catheter, intravenous fluids, antibiotics till resuscitation and correction of metabolic and electrolyte disturbance if present. Then treated by laparoscopic adhesiolysis within 48 hours of conservative management. Recording the data of timing of intervention from beginning of the symptoms, the operation time, the success rate, the incidence of complications, the length of the hospital stay and conversion to open laparotomy and data of follow-up.
Results: Total operative time rang from 40-190 minutes which was statistically significant in correlation with bowel edema, types of adhesions, attacks of recurrence and previous abdominal operations with a p-value 0.039, 0.015, 0.024, 0.042 respectively. There was statistical significant of total hospital stay in correlation with timing of intervention and operative time, p-value 0.041, 0.032 respectively.
Conclusions: The convenience of laparoscopic manage-ment of the correctly selected patients with small bowel obstruction is demonstrated by operative time, short hospital stay, and early oral intake and especially by the lower post-operative morbidity.