Harvitkar Rafique Umer, Kumar Peri Harish, Joshi Abhijit
General Surgery, Dr Lakhumal Hiranand Hiranandani Hospital, Mumbai, IND.
Department of Surgery, Armed Forces Medical College, Pune, IND.
Cureus. 2021 Oct 16;13(10):e18828. doi: 10.7759/cureus.18828. eCollection 2021 Oct.
Laparotomy (open surgery) is considered the standard approach for acute small bowel obstruction (ASBO). However, with the advent of minimally invasive surgery, the laparoscopic approach is gaining popularity. There is no consensus on the appropriate setting for laparoscopic therapy for small bowel obstruction (SBO).
The purpose of this study is to evaluate the outcomes of laparoscopic surgery for ASBO.
We retrospectively evaluated the prospectively collected data of all the 38 patients who had undergone laparoscopy for ASBO, performed by a single surgeon at our institution, due to adhesions (30 patients), internal hernias (five patients), midgut malrotation (one patient), ileo-ileal intussusception (one patient), and superior mesenteric artery (SMA) syndrome (one patient) from 2012 to 2020. Data were extracted from the hospital electronic medical records (EMR) for the following parameters of each individual patient: age, sex, clinical presentation, preoperative investigation findings, final diagnosis, surgical details, operating time, time to postoperative oral feeds, length of hospital stay, complications, recurrences, and time taken to resume normal activity. A preoperative abdominal contrast-enhanced computed tomography (CECT) was performed in all the cases. Patients with peritonitis and septic shock were excluded from the study. Results: The mean age of the 38 patients was 58 years (ranged between 33 and 83 years) with a standard deviation (SD) of 16.5. The mean age of the female patients in the study was 60.5 years with an SD of 16.6, while the mean age of the male patients was 54.9 years (SD = 16.2). The age difference between male and female patients in the study was not statistically significant (p = 0.36). The mean operating time was 74.4 minutes (range: 60-90 minutes, with an SD of 7.2). The mean time to oral liquid/soft diet was 2.5 days. The mean postoperative stay was 5.7 days. Three patients (8%) underwent conversion to open surgery, out of which two patients had multiple complex bowel-to-bowel and bowel-to-parietes adhesions, and in one patient, massive distension of small bowel caused technical difficulties.
Laparoscopic management of ASBO is feasible, effective, and safe. Optimum surgical techniques, the surgeon's experience with the procedure, and stringent patient selection criteria enable a high probability of success.
剖腹手术（开放手术）被认为是急性小肠梗阻（ASBO）的标准治疗方法。然而，随着微创手术的出现，腹腔镜手术方法越来越受欢迎。对于小肠梗阻（SBO）的腹腔镜治疗的合适时机尚无共识。
本研究的目的是评估ASBO的腹腔镜手术效果。
我们回顾性评估了前瞻性收集的由我院一名外科医生在2012年至2020年期间为38例因粘连（30例）、内疝（5例）、中肠旋转不良（1例）、回肠套叠（1例）和肠系膜上动脉（SMA）综合征（1例）而接受ASBO腹腔镜手术的患者的数据。从医院电子病历（EMR）中提取每位患者的以下参数：年龄、性别、临床表现、术前检查结果、最终诊断、手术细节、手术时间、术后开始经口进食时间、住院时间、并发症、复发情况以及恢复正常活动所需时间。所有病例均进行了术前腹部增强计算机断层扫描（CECT）。腹膜炎和感染性休克患者被排除在研究之外。结果：38例患者的平均年龄为58岁（范围为33至83岁），标准差（SD）为16.5。研究中女性患者的平均年龄为60.5岁，SD为16.6，而男性患者的平均年龄为54.9岁（SD = 16.2）。研究中男性和女性患者的年龄差异无统计学意义（p = 0.36）。平均手术时间为74.4分钟（范围：60 - 90分钟，SD为7.2）。开始口服液体/软食的平均时间为2.5天。术后平均住院时间为5.7天。3例患者（8%）转为开放手术，其中2例患者有多处复杂的肠与肠及肠与腹壁粘连，1例患者小肠大量扩张导致技术困难。
ASBO的腹腔镜治疗是可行、有效且安全的。最佳的手术技术、外科医生的手术经验以及严格的患者选择标准使得手术成功的可能性很高。
