Langenbeck's archives of surgery · 2009
Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Grafen Franziska Carmen, Neuhaus Valentin, Schöb Othmar, Turina Matthias
Аннотация
PURPOSE: The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery.
MATERIALS AND METHODS: Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients).
RESULTS: Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique.
CONCLUSIONS: A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.
MATERIALS AND METHODS: Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients).
RESULTS: Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique.
CONCLUSIONS: A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.
Предметные рубрики MeSH
Acute DiseaseAdultAgedCohort StudiesFemaleFollow-Up StudiesHospitals, TeachingHumansIntestinal ObstructionIntestine, SmallLaparoscopyLaparotomyMaleMiddle AgedMinimally Invasive Surgical ProceduresPostoperative ComplicationsPreoperative CareProbabilityRetrospective StudiesRisk AssessmentSeverity of Illness IndexTissue AdhesionsTreatment Outcome