Is Exploratory Laparoscopy the Optimal Surgical Strategy for Small Bowel Obstruction? A Single-Center Retrospective Cohort Study With Propensity Score-Matched Analysis.

INTRODUCTION

No consensus exists on the optimal surgical strategy for small bowel obstruction (SBO). Therefore, we assessed the feasibility of laparoscopic surgery (LS) for SBO by comparing LS and open surgery (OS) outcomes.

METHODS

We retrospectively analyzed 303 patients who underwent surgery for SBO. The characteristics of 233 patients who underwent exploratory LS, including 43 who underwent open conversion surgery (OCS) and 70 who underwent OS, were propensity score-matched to compare surgical outcomes. Risk factors and a predictive model for OCS were also investigated.

RESULTS

After matching, patients who underwent LS had smaller hemorrhage volumes, fewer severe postoperative complications, and shorter postoperative hospital stays than those who underwent OS. Furthermore, the recurrence rates were comparable. The surgical outcomes of patients who underwent OCS were generally inferior to those of patients who completed LS and were almost equivalent to those of patients who underwent OS. A history of abdominal surgery, serum albumin level ≤ 3.8 g/dL, platelet count ≤ 15 × 104/μL, and neutrophil-to-lymphocyte ratio ≥ 6.7 were identified as independent risk factors for OCS. The OCS risk was significantly higher when the predictive model for conversion to OS was derived from risk factors scoring ≥ 10.

CONCLUSION

Overall, LS for SBO yields better outcomes than OS. Even in patients with a high predicted risk of conversion to OS, exploratory laparoscopy should be the primary surgical procedure for treating SBO.