Petrou Nikoletta A, Bonelli Eugenia M, Watson Naomi, Wood Jonathan, Kontovounisios Christos, Behar Nebil
Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK.
Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK.
J Clin Med. 2022 Oct 25;11(21):6275. doi: 10.3390/jcm11216275.
The laparoscopic approach to the management of small bowel obstruction (SBO) has been associated with reduced length of hospital stay, complications, and mortality. The laparoscopy-first approach has been limited to highly selective cases to date. In this retrospective observational study, we report our 10-year experience and outcomes within a dedicated Emergency Surgery unit that adopted a non-selective approach in the laparoscopic management of SBO. The surgical approach to all patients that underwent surgery for SBO by an experienced Emergency Surgeon, over a period of 10 years, was divided into two groups of open surgery (OS) or laparoscopy-first (LF). Outcomes included length of stay, complications, mortality, readmission rates and reasons for conversion. Data were reviewed to identify patterns of learning. A total of 189 patients were included in the study. A total of 81.5% were managed with an LF approach. Of these, 25.3% required conversion. LF patients had a similar length of stay, lower 30-day readmission rates and wound complications. Reasons for conversion included need for bowel resection, perforation, and malignancy. Our study had a high intention-to-treat LF population and identified major indications for conversion. As our laparoscopic experience increased, conversion rates substantially reduced. We propose that a LF approach is feasible and can benefit from training within dedicated Emergency Surgery teams.
腹腔镜治疗小肠梗阻（SBO）与缩短住院时间、减少并发症及降低死亡率相关。迄今为止，腹腔镜优先 approach 仅限于高度选择性病例。在这项回顾性观察研究中，我们报告了我们在一个专门的急诊外科单元的 10 年经验和结果，该单元在 SBO 的腹腔镜治疗中采用了非选择性 approach。在 10 年期间，由一位经验丰富的急诊外科医生为所有接受 SBO 手术的患者所采用的手术 approach 分为开放手术（OS）或腹腔镜优先（LF）两组。结果包括住院时间、并发症、死亡率、再入院率及中转原因。对数据进行回顾以确定学习模式。共有 189 例患者纳入研究。共有 81.5%的患者采用 LF approach 进行治疗。其中，25.3%的患者需要中转。LF 组患者的住院时间相似，30 天再入院率和伤口并发症较低。中转原因包括需要肠切除、穿孔和恶性肿瘤。我们的研究有很高比例的意向性治疗 LF 人群，并确定了中转的主要指征。随着我们腹腔镜经验的增加，中转率大幅降低。我们认为 LF approach 是可行的，并且可以从专门的急诊外科团队的培训中获益。
