Lujan Henry J, Oren Aeyal, Plasencia Gustavo, Canelon Gustavo, Gomez Eddie, Hernandez-Cano Alejandro, Jacobs Moises
Advanced Surgical Institute, Miami, Florida, USA.
JSLS. 2006 Oct-Dec;10(4):466-72.
We prospectively evaluated our experience with laparoscopic management of acute small bowel obstruction (SBO).
The study group included all patients requiring surgical intervention based on complete mechanical SBO by clinical assessment or who had failed conservative management. Patients with malignant causes were excluded. Experienced laparoscopic surgeons performed all operations.
Between January 1998 to January 2003, 61 patients required operative intervention for acute SBO. Causes included adhesions, internal hernia, incarcerated incisional hernia, and inflammatory bowel disease. Laparoscopic techniques (LAP) alone were successfully used to complete 41 cases (67%). Twenty patients (33%) were converted (CONV) to either mini-laparotomy [7 patients (35%)] or standard midline laparotomy [13 patients (65%)]. A single band was identified in 25 patients (41%). Complications occurred in both groups.
We believe all patients requiring surgery in the setting of acute small bowel obstruction should undergo a laparoscopic approach initially. By specifically identifying those patients with a single band as the cause of obstruction, a significant number of patients will be spared a large laparotomy incision. Conversion should not be viewed as failure, but rather, a sometimes necessary step in the optimal management of these patients.
我们前瞻性地评估了腹腔镜治疗急性小肠梗阻（SBO）的经验。
研究组包括所有根据临床评估因完全机械性SBO需要手术干预或保守治疗失败的患者。排除恶性病因患者。所有手术均由经验丰富的腹腔镜外科医生进行。
1998年1月至2003年1月期间，61例患者因急性SBO需要手术干预。病因包括粘连、内疝、嵌顿性切口疝和炎性肠病。单纯腹腔镜技术（LAP）成功完成41例（67%）。20例患者（33%）中转（CONV）为小切口剖腹术[7例患者（35%）]或标准中线剖腹术[13例患者（65%）]。25例患者（41%）发现单一粘连带。两组均发生并发症。
我们认为，所有在急性小肠梗阻情况下需要手术的患者应首先采用腹腔镜方法。通过专门识别那些以单一粘连带为梗阻原因的患者，大量患者将避免大的剖腹切口。中转不应被视为失败，而应视为这些患者最佳治疗中有时必要的一步。
