From the Department of General Surgery (S.L., K.B., J.D.F.), University of Utah, Salt Lake City, Utah; Section of Trauma and Critical Care (R.N.), Department of Surgery, University of Utah, Salt Lake City, Utah.
J Trauma Acute Care Surg. 2014 Mar;76(3):696-703. doi: 10.1097/TA.0000000000000156.
Celiotomy is the most common approach for refractory small bowel obstruction (SBO). Small reviews suggest that a laparoscopic approach is associated with shorter stay and less morbidity. Given the limitations of previous studies, we sought to evaluate outcomes of laparoscopic (L) compared with open (O) adhesiolysis for SBO, using the National Surgical Quality Improvement Program data set.
Patients from the American College of Surgeons' National Surgical Quality Improvement Program 2005 to 2009 database who underwent surgery for SBO were stratified based on surgical approach. A propensity score to undergo L instead of O was calculated based on demographics, comorbidities, physiology, and laboratory values. Logistic regression was then used to determine differences in outcomes between those propensity score-matched patients who actually underwent L compared with O surgery.
There were 6,762 patients who underwent adhesiolysis. The propensity score-matching process created 222 matched patients in L and O groups. Laparoscopy was associated with significantly lower rates of any complication (odds ratio [OR] 0.41; 95% confidence interval [CI], 0.28-0.60), including superficial site infections (OR, 0.15; 95% CI, 0.05-0.49), intraoperative transfusion (OR, 0.22; 95% CI, 0.05-0.90), and shorter hospital stay (4 days vs. 10 days; p < 0.001). There was no significant difference in operative time, rates of reoperation within 30 days, or mortality.
Laparoscopic treatment of SBO is associated with lower rates of postoperative morbidity compared with laparotomy as well as shorter hospital stay. Laparoscopic treatment of surgical SBO is not associated with higher rates of early reoperation and seems to be associated with lower resource use.
Therapeutic study, level IV.
剖腹术是治疗难治性小肠梗阻（SBO）最常见的方法。小型综述表明，腹腔镜方法与较短的住院时间和较低的发病率相关。鉴于先前研究的局限性，我们试图使用国家手术质量改进计划数据集评估腹腔镜（L）与开腹（O）粘连松解术治疗 SBO 的结果。
根据手术方法将美国外科医师学会国家手术质量改进计划数据库 2005 年至 2009 年期间接受 SBO 手术的患者分层。根据人口统计学、合并症、生理学和实验室值计算接受 L 而不是 O 的倾向评分。然后使用逻辑回归确定实际接受 L 与 O 手术的患者之间在结局上的差异。
有 6762 例患者接受了粘连松解术。倾向评分匹配过程创建了 222 例 L 和 O 组匹配患者。腹腔镜手术与任何并发症的发生率显著降低相关（比值比 [OR] 0.41；95%置信区间 [CI]，0.28-0.60），包括浅表部位感染（OR，0.15；95% CI，0.05-0.49）、术中输血（OR，0.22；95% CI，0.05-0.90）和较短的住院时间（4 天与 10 天；p < 0.001）。手术时间、30 天内再次手术的发生率或死亡率没有显著差异。
与剖腹术相比，腹腔镜治疗 SBO 与较低的术后发病率以及较短的住院时间相关。腹腔镜治疗外科 SBO 与较高的早期再手术率无关，似乎与较低的资源利用相关。
治疗性研究，IV 级。
