Ortolano E, Maina C, D'Addiego A, Ciuffa C, Rocchetti S I, Beneduce A A, Carlucci M
Emergency and General Surgery, I.R.C.C.S. San Raffaele Hospital, via Olgettina 60, 20132, Milan, Italy.
General Surgery Residency, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
Surg Pract Sci. 2023 Aug 25;14:100213. doi: 10.1016/j.sipas.2023.100213. eCollection 2023 Sep.
Acute small bowel obstruction (aSBO) is the most common cause (76%) of acute intestinal obstruction. Laparoscopy use is still controversial in aSBO and indications not yet clearly defined. The aim of this study was to demonstrate the effectiveness and safety of a laparoscopic approach in aSBO by using specific pre-operative criteria for appropriate patient selection.
We retrospectively analyzed medical records of patients accepted at the Emergency Department for aSBO between January 2016 and March 2021 and performed a comparative analysis between types of treatment, considering demographics, clinical and radiological presentation, non-operative vs. operative management, intraoperative outcome, and postoperative course. We used a logistic regression to identify the variables related to surgical approach and built a predictive score upon the multivariable predictive model: the "SABO score".
198 patients were included in the study, of which 145 underwent surgery and 43 were successfully treated laparoscopically. Age and comorbidities were associated with open surgery (OR 3.2, 95% CI: 1.4-7.2, = 0.006 and OR 2.7, 95% CI: 1.1-6.5, = 0.023). A SABO score ≥ 0 identified an open approach with a sensitivity of 75.4% and a specificity of 69.8%.
Laparoscopy is growing in importance even in emergency settings. Our analysis suggests that a laparoscopic approach can be safe and feasible in aSBO management. Correct patient selection appears to be the key for a successful minimally invasive approach. SABO score therefore could be helpful in choosing the correct surgical strategy for patients with aSBO.
急性小肠梗阻（aSBO）是急性肠梗阻最常见的病因（76%）。腹腔镜检查在aSBO中的应用仍存在争议，其适应证尚未明确界定。本研究的目的是通过使用特定的术前标准进行合适的患者选择，来证明腹腔镜手术治疗aSBO的有效性和安全性。
我们回顾性分析了2016年1月至2021年3月在急诊科接受治疗的aSBO患者的病历，并对治疗类型进行了比较分析，考虑了人口统计学、临床和影像学表现、非手术与手术治疗、术中结果和术后病程。我们使用逻辑回归来确定与手术方式相关的变量，并基于多变量预测模型建立了一个预测评分：“SABO评分”。
198例患者纳入本研究，其中145例行手术治疗，43例成功接受腹腔镜手术。年龄和合并症与开放手术相关（OR 3.2，95%CI：1.4 - 7.2，P = 0.006；OR 2.7，95%CI：1.1 - 6.5，P = 0.023）。SABO评分≥0识别出开放手术方式，其敏感性为75.4%，特异性为69.8%。
即使在急诊情况下，腹腔镜检查的重要性也在不断增加。我们的分析表明，腹腔镜手术治疗aSBO是安全可行的。正确的患者选择似乎是成功实施微创方法的关键。因此，SABO评分可能有助于为aSBO患者选择正确的手术策略。
