1
|
Rashid A, Kumar M, Lee MJ. A systematic review of participant descriptors reported in studies of adhesive small bowel obstruction. Colorectal Dis 2024. [PMID: 38609340 DOI: 10.1111/codi.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 11/05/2023] [Indexed: 04/14/2024]
Abstract
AIM Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO. METHOD This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team. RESULTS Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study. CONCLUSION There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.
Collapse
Affiliation(s)
- Adil Rashid
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Mithun Kumar
- Department of General Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| |
Collapse
|
2
|
Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
Collapse
Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| |
Collapse
|
3
|
Elkomos BE, Fahmy K, Kamel KA. Laparoscopic adhesiolysis versus open adhesiolysis in acute adhesive small bowel obstruction. J Minim Access Surg 2023; 19:511-517. [PMID: 37357493 PMCID: PMC10695316 DOI: 10.4103/jmas.jmas_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/11/2023] [Accepted: 04/07/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction Exploratory laparotomy is still the standard therapy for patients who need surgical intervention for adhesive small bowel obstruction (SBO). However, the use of laparoscopy in the management of adhesive SBO is still controversial. We aimed to detect the short-term outcomes between open and laparoscopic adhesiolysis for SBO. Patients and Methods This is a retrospective study of patients with adhesive SBO who underwent either laparoscopic or open surgery from June 2019 to July 2022 at Ain Shams University Hospitals. Intraoperative and early post-operative outcomes were compared in the two groups. Results A total of 89 patients with adhesive SBO were included in our study. Fifty-one cases underwent open adhesiolysis and 38 cases underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is associated with a remarkable decrease in the operative time (71 min vs. 107 min, P = 0.001) and blood loss (50 ml vs. 120 ml, P = 0.001) in comparison to open adhesiolysis. In addition to that, those who underwent adhesiolysis by laparoscopy had a short hospital stay (2.4 days vs. 3.8 days, P = 0.001), early recovery (time to pass flatus 1.3 days vs. 2.8 days) and less post-operative complications (surgical site infection [SSI] 2.6% vs. 19.6%, P = 0.001). Moreover, open adhesiolysis is associated with a higher rate of early post-operative mortality. In addition to that, the incidence of iatrogenic injury was higher in the open group. Conclusion Laparoscopic adhesiolysis is a safe and feasible approach for the management of SBO and has better short-term outcomes, especially if done by skilled surgeons in advanced laparoscopic techniques.
Collapse
Affiliation(s)
| | - Karim Fahmy
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
| | - Kareem Ahmed Kamel
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
| |
Collapse
|
4
|
Girón F, Chaves CER, Rodríguez L, Rueda-Esteban RJ, Núñez-Rocha RE, Pedraza JD, Conde D, Vanegas M, Nassar R, Herrera G, Hernández JD. Association between clinical and surgical variables with postoperative outcomes in patients treated for intestinal obstruction for non-malignant conditions: a cross-sectional study. Sci Rep 2023; 13:14544. [PMID: 37666937 PMCID: PMC10477176 DOI: 10.1038/s41598-023-41328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
Intestinal obstruction is considered a frequent surgical pathology related to previous surgical procedures. Many different factors can lead to different outcomes when surgical management is needed. Therefore, we aim to describe the factors related to morbidity and mortality in surgical management of IO in a single-center experience. Retrospective observational study with a prospective database, in which we described patients who underwent surgical management due to intestinal obstruction between 2004 and 2015. Demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. 366 patients were included. Female were 54.6%. Mean age was 61.26. Laparoscopic approach was done in 21.8% and the conversion rate was 17.2%. Intestinal resection was performed in 37.9% of the cases. Postoperative complications were observed in 18.85%. Reintervention and mortality were 9.5% and 4.1% respectively. Laparoscopic approach shows lesser time of intestinal transit (mean 28.67 vs. mean 41.95 h), and restart of oral intake after surgery (mean 96.06 vs. mean 119.65) compared with open approach. Increased heart rate and intensive care unit length of stay were related with mortality (p 0.01 and 0.000 respectively). For morbidity, laparotomy and need and duration of ICU stay were related with any complication statistically significant (p 0.02, 0.008, 0.000 respectively). Patients with increased heart rate in the emergency room, decreased amount of intravenous fluids, need and higher length of stay in the intensive care unit, and delay in resuming oral intake after surgery appear to have poor outcomes. Laparoscopic approach seems to be a safe and feasible approach for intestinal obstruction in selected patients.
Collapse
Affiliation(s)
- Felipe Girón
- Department of Surgery, Fundación Santa Fé de Bogotá, Carrera 7 # 117 - 15, 111711, Bogotá, D.C, Colombia.
- School of Medicine, Universidad del Rosario, 111711, Bogotá D.C, Colombia.
- School of Medicine, Universidad de los Andes, 111711, Bogotá D.C, Colombia.
| | | | - Lina Rodríguez
- School of Medicine, Universidad de los Andes, 111711, Bogotá D.C, Colombia
| | | | | | | | - Danny Conde
- School of Medicine, Universidad del Rosario, 111711, Bogotá D.C, Colombia
| | - Marco Vanegas
- School of Medicine, Universidad del Rosario, 111711, Bogotá D.C, Colombia
| | - Ricardo Nassar
- Department of Surgery, Fundación Santa Fé de Bogotá, Carrera 7 # 117 - 15, 111711, Bogotá, D.C, Colombia
- School of Medicine, Universidad del Rosario, 111711, Bogotá D.C, Colombia
- School of Medicine, Universidad de los Andes, 111711, Bogotá D.C, Colombia
| | - Gabriel Herrera
- Department of Surgery, Fundación Santa Fé de Bogotá, Carrera 7 # 117 - 15, 111711, Bogotá, D.C, Colombia
- School of Medicine, Universidad de los Andes, 111711, Bogotá D.C, Colombia
| | - Juan David Hernández
- Department of Surgery, Fundación Santa Fé de Bogotá, Carrera 7 # 117 - 15, 111711, Bogotá, D.C, Colombia
- School of Medicine, Universidad de los Andes, 111711, Bogotá D.C, Colombia
| |
Collapse
|
5
|
Sebastian-Valverde E, Téllez C, Burdío F, Poves I, Grande L. Individualization of the best approach for adhesive small bowel obstruction. ANZ J Surg 2023; 93:2132-2137. [PMID: 37530170 DOI: 10.1111/ans.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Laparoscopic postoperatives outcomes in adhesiolysis are promising but conversion and morbidity remains high. The objective of our study was to determine preoperative factors to individualize and select the most appropriate approach for each patient. METHODS Patients ≥18 years old undergoing emergent surgery for adhesive small bowel obstruction and internal hernias were evaluated. Bivariate and multivariate analysis were performed to investigate factors related to conversion to open surgery and to the type of adhesions. RESULTS Of 333 patients, 224 were operated by laparotomy and 109 by laparoscopy (conversion rate: 40%). Previous abdominal wall mesh, type of adhesions, bowel lesion, need for intestinal resection and laparoscopic skills were statistically related to conversion. In the multivariate analysis, complex adhesions (OR 4.3, 95% CI 1.5-12.2; P = 0.006), the need for intestinal resection (OR 14.16, 95% CI 2.55-78.68; P = 0.002), and non-advanced laparoscopy surgeons (OR 4.31, 95% CI 1.56-11.94; P = 0.005) were independent factors for conversion to open surgery. ASA III-IV, previous surgeries, previous abdominal mesh and previous adhesiolysis were related to complex adhesions. Previous laparoscopic surgery and internal hernia or closed loop in computed tomography were associated with simple adhesions as a cause of the obstruction. In the multivariate, previous adhesiolysis (OR 4.76, 95% CI 1.23-18.3; P = 0.023) and the findings on computed tomography were significantly related with the type of adhesion. CONCLUSION Some preoperative factors allow to individualize the surgical approach in the adhesive small bowel obstruction improving surgical outcomes.
Collapse
Affiliation(s)
- Enric Sebastian-Valverde
- Department of Surgery, Hospital de Sant Boi, Sant Boi de Llobregat, Spain
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Clara Téllez
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Fernando Burdío
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
- Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ignasi Poves
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Luis Grande
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Das SS, Krishnan S, Albedwawi MH, Bondok W, Shalak H. Post-appendectomy Adhesive Small Intestine Obstruction With Gangrene: A Sinister Case. Cureus 2023; 15:e39437. [PMID: 37378224 PMCID: PMC10292044 DOI: 10.7759/cureus.39437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Intestinal adhesions are fibrotic bands of scar tissue that develop intra-abdominally due to serosal or peritoneal irritation caused during surgery or by severe infections. It may also occur congenitally. It can lead to serious complications such as small bowel obstruction, which is then termed adhesive small bowel obstruction. In this scenario, it can constrict the bowel wall and cause ischemia and necrosis of the affected intestinal segment. Computed tomography imaging may show characteristic signs, such as the "whirl sign" or "fat-bridging sign." Diagnostic laparoscopy or laparotomy can confirm the diagnosis and presence of adhesions. Management of this condition is either conservative or surgical, the latter of which is necessary in the case of intestinal strangulation. While the literature supports the laparoscopic method of adhesiolysis, practically, it may present technical difficulties. Surgeons should employ their clinical judgment in cases where an open procedure may be more beneficial. We present a case of this very occurrence and discuss the risk factors, pathogenesis, diagnostic evaluation, and, finally, the approaches to surgical management of this condition.
Collapse
|
7
|
Mare H, Tjhin W. Successful Laparoscopic Management of Pericaecal Hernia Causing Small Bowel Obstruction. Cureus 2023; 15:e34663. [PMID: 36909093 PMCID: PMC9993124 DOI: 10.7759/cureus.34663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Management of small bowel obstruction varies depending on the cause and clinical status of patients. While most cases can be managed conservatively, a not-insignificant proportion of patients undergo surgical intervention. Laparotomy has long been the default approach for entering the abdomen in cases requiring surgical intervention, with laparoscopy largely being avoided due to abdominal distension and the risk of perforating bowels on entry. We present here the case of a 54-year-old woman who presented with signs and symptoms as well as radiological evidence of a closed-loop small bowel obstruction in her right lower quadrant. Following a brief period of nasogastric decompression, her abdominal distension improved, allowing for a laparoscopic entry where a pericaecal hernia was noted to be the cause of her obstruction. Extensive adhesiolysis without the use of an energy device successfully allowed for the reduction of the bowel contained within. No bowel resection was performed and the patient was discharged home on day 3 following her procedure. This case report successfully demonstrates the utility of using laparoscopy as an alternative to laparotomy in patients with a small bowel obstruction secondary to an internal hernia.
Collapse
Affiliation(s)
- Hans Mare
- General Surgery, Rockingham General Hospital, Rockingham, AUS
| | - William Tjhin
- General Surgery, Rockingham General Hospital, Rockingham, AUS
| |
Collapse
|
8
|
Olausson M, Aerenlund MP, Azzam M, Bjerke T, Burcharth JFH, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Ngo-Stuyt L, Nielsen EØ, Nielsen LBJ, Skovsen AP, Tolver MA, Smith HG. Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study. Eur J Trauma Emerg Surg 2022; 49:1121-1130. [PMID: 36357790 PMCID: PMC9648885 DOI: 10.1007/s00068-022-02171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Abstract
AIMS The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates. RESULTS 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%. CONCLUSIONS The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations. TRIAL REGISTRATION Trial registration number: NCT04750811. Trial registration date: 11/02/2021.
Collapse
Affiliation(s)
- M Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - M P Aerenlund
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J F H Burcharth
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - H G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
9
|
Brito-Rojas IC, Neil Valentín Vega-Peña NVVP. Obstrucción intestinal por adherencias: un lienzo en blanco en el que el cirujano elige los colores. Rev Colomb Cir 2022. [DOI: 10.30944/20117582.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introducción. La obstrucción intestinal es una patología de alta prevalencia. Su abordaje diagnóstico y terapéutico ha evolucionado acorde con el avance del conocimiento e implementación de la tecnología. El impacto de sus complicaciones obliga a redoblar esfuerzos en pro de lograr una mayor efectividad. Se hizo una aproximación reflexiva al problema, mediante una identificación de los puntos controversiales de interés para el cirujano general.
Métodos. Se realizó una búsqueda sistemática de la literatura en varias bases de datos, utilizando dos ecuaciones de búsqueda que emplearon términos seleccionados a partir de los tesauros “Medical Subject Heading” (MeSH) y “Descriptores en Ciencias de la Salud” (DeCS).
Resultados. Se recolectaron 43 artículos y a partir de ellos se construyó el texto de revisión. La identificación pronta de los posibles candidatos a cirugía, mediante un esquema diagnóstico y terapéutico, se constituye en una prioridad en el manejo de estos pacientes. De igual manera, se efectúan consideraciones en la toma de decisiones con respecto a la vía quirúrgica, así como recomendaciones técnicas operatorias producto de la experiencia y lo reportado en la literatura. Existen factores propios del cirujano, del contexto y del paciente, que inciden en la resolución del problema.
Conclusión. La obstrucción intestinal y sus implicaciones clínicas obligan a una reevaluación constante de su estado del arte y avances en el manejo, tendiente a una búsqueda de oportunidades para impactar favorablemente en su curso clínico. Hay estrategias por implementar, inclusive el manejo laparoscópico en casos seleccionados.
Collapse
|
10
|
Tazeoğlu D, Benli S, Tikici D, Esmer AC, Dirlik MM. Can minimally invasive surgical techniques reduce
the incidence of postoperative adhesions? Pol Przegl Chir 2022; 94:23-30. [DOI: 10.5604/01.3001.0015.7342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<br><b>Introduction:</b> Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.</br>
<br><b>Aim:</b> This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.</br>
<br><b>Material and methods:</b> Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).</br>
<br><b>Results:</b> One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39–82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p < 0.05).</br>
<br><b>Conclusions:</b> Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.</br>
Collapse
Affiliation(s)
- Deniz Tazeoğlu
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Sami Benli
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Deniz Tikici
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Ahmet Cem Esmer
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Mustafa Musa Dirlik
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| |
Collapse
|
11
|
Mo J, Gao L, Zhang N, Xie J, Li D, Shan T, Fan L. Structural and quantitative alterations of gut microbiota in experimental small bowel obstruction. PLoS One 2021; 16:e0255651. [PMID: 34347831 PMCID: PMC8336877 DOI: 10.1371/journal.pone.0255651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/21/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate structural and quantitative alterations of gut microbiota in an experimental model of small bowel obstruction. METHOD A rat model of small bowel obstruction was established by using a polyvinyl chloride ring surgically placed surrounding the terminal ileum. The alterations of gut microbiota were studied after intestinal obstruction. Intraluminal fecal samples proximal to the obstruction were collected at different time points (24, 48 and 72 hours after obstruction) and analyzed by 16s rDNA high-throughput sequencing technology and quantitative PCR (qPCR) for target bacterial groups. Furthermore, intestinal claudin-1 mRNA expression was examined by real-time polymerase chain reaction analysis, and serum sIgA, IFABP and TFF3 levels were determined by enzyme-linked immunosorbent assay. RESULTS Small bowel obstruction led to significant bacterial overgrowth and profound alterations in gut microbiota composition and diversity. At the phylum level, the 16S rDNA sequences showed a marked decrease in the relative abundance of Firmicutes and increased abundance of Proteobacteria, Verrucomicrobia and Bacteroidetes. The qPCR analysis showed the absolute quantity of total bacteria increased significantly within 24 hours but did not change distinctly from 24 to 72 hours. Further indicators of intestinal mucosa damage and were observed as claudin-1 gene expression, sIgA and TFF3 levels decreased and IFABP level increased with prolonged obstruction. CONCLUSION Small bowel obstruction can cause significant structural and quantitative alterations of gut microbiota and induce disruption of gut mucosa barrier.
Collapse
MESH Headings
- Animals
- Bacteroidetes/genetics
- Claudin-1/genetics
- DNA, Bacterial/genetics
- DNA, Bacterial/isolation & purification
- DNA, Ribosomal/genetics
- DNA, Ribosomal/isolation & purification
- Disease Models, Animal
- Feces/microbiology
- Firmicutes/genetics
- Gastrointestinal Microbiome/genetics
- Gene Expression
- Ileum/microbiology
- Ileum/pathology
- Immunoglobulin A, Secretory/blood
- Immunoglobulin A, Secretory/metabolism
- Intestinal Mucosa/immunology
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/microbiology
- Intestinal Obstruction/blood
- Intestinal Obstruction/microbiology
- Male
- Phylogeny
- Proteobacteria/genetics
- RNA, Ribosomal, 16S/genetics
- Rats
- Rats, Wistar
- Verrucomicrobia/genetics
Collapse
Affiliation(s)
- Jiali Mo
- Graduate school of Tianjin Medical University, Tianjin, China
| | - Lei Gao
- Graduate school of Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Department of Gastrointestinal Surgery, Nankai Hospital, Tianjin, China
| | - Jiliang Xie
- Department of Gastrointestinal Surgery, Nankai Hospital, Tianjin, China
| | - Donghua Li
- Department of Pharmacology, Tianjin Nankai Hospital, Tianjin, China
| | - Tao Shan
- Department of Gastrointestinal Surgery, Nankai Hospital, Tianjin, China
| | - Liuyang Fan
- Graduate school of Tianjin Medical University, Tianjin, China
| |
Collapse
|
12
|
Tepelenis K, Stefanou SK, Stefanou CK, Tepelenis N, Margariti P, Christopoulou A, Gogos-Pappas G, Vlachos K. Small bowel obstruction due to a congenital adhesion: a rare case report. J Surg Case Rep 2021; 2021:rjab282. [PMID: 34234943 PMCID: PMC8257260 DOI: 10.1093/jscr/rjab282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/10/2021] [Indexed: 01/18/2023] Open
Abstract
The exact incidence of small bowel obstruction (SBO) due to congenital adhesions remains unclear. Herein, we report a 59-year-old male who appeared in the emergency department with diffuse abdominal pain associated with vomiting. The patient reported no previous medical or surgical history. Clinical examination revealed a soft, distended abdomen and diffuse tenderness. Computed tomography indicated a close loop obstruction. A congenital band extending from mesentery to ileum and causing an internal hernia was identified via a midline incision. The band was ligated and divided. There is no difference in the clinical presentation, and the initial work-up of SBO on account of congenital adhesions was compared to other bowel obstruction causes. Surgical exploration is crucial for the diagnosis and treatment of congenital adhesions. Although laparotomy is considered the cornerstone of surgical management, laparoscopy has emerged as a feasible and safe alternative for the diagnosis and treatment of these congenital bands.
Collapse
Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Stefanos K Stefanou
- Department of Surgery, General Hospital of Ioannina G. Xatzikosta, Ioannina, Greece
| | | | | | | | | | | | | |
Collapse
|
13
|
Heywood N, Parmar KL, Stott M, Sodde P, Doherty DT, Lim J, Sharma A. The laparoscopy in emergency general surgery (LEGS) study: a questionnaire survey of UK practice. Ann R Coll Surg Engl 2021; 103:120-129. [PMID: 33559556 PMCID: PMC9773896 DOI: 10.1308/rcsann.2020.7005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Recent consensus guidelines suggest that the laparoscopic approach may be a useful, safe and feasible approach in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) suggests the rate of laparoscopy is low (9% fully laparoscopic) and slow to increase over time. A European survey found uptake to be variable. This UK survey was therefore undertaken to establish current UK practice and to determine factors affecting implementation. MATERIALS AND METHODS A questionnaire survey of currently practising UK consultant general surgeons was carried out by the North West Surgical Research Collaborative, using a secure web-based database maintained by the North West Surgical Trials Centre. RESULTS A total of 151 completed questionnaires were returned from 22 UK centres; 18% of respondents were unaware that laparoscopic cases should be reported to NELA. Appendicectomy (97%) and cholecystectomy (87%) were routinely performed laparoscopically. Laparoscopy was infrequently used in perforation, ischaemia or obstructed hernias. There appears to be equipoise regarding laparoscopic compared with open surgery in small-bowel obstruction among all subspecialty emergency general surgeons, in perforated peptic ulcer among upper gastrointestinal surgeons and in Hinchey III diverticulitis among colorectal surgeons. CONCLUSION Uptake of laparoscopy in UK emergency general surgery is influenced by surgeon preference, subspecialty, patient and operative factors. Further research into outcomes may help to identify areas of greatest potential benefit. The rate of laparoscopy reported by NELA may be an underestimate due to the 18% of surgeons unaware that laparoscopic cases should be reported, which may affect the validity of analyses performed from this dataset.
Collapse
Affiliation(s)
- N Heywood
- General Surgery Training Programme, Health Education North West England, Manchester, UK
| | | | - M Stott
- General Surgery Training Programme, Health Education North West England, Manchester, UK
| | - P Sodde
- General Surgery Training Programme, Health Education North West England, Manchester, UK
| | - DT Doherty
- General Surgery Training Programme, Health Education North West England, Manchester, UK
| | - J Lim
- General Surgery Training Programme, Health Education North West England, Manchester, UK
| | - A Sharma
- Manchester University NHS Foundation Trust, Manchester, UK
| | | |
Collapse
|
14
|
Krielen P, Di Saverio S, Ten Broek R, Renzi C, Zago M, Popivanov G, Ruscelli P, Marzaioli R, Chiarugi M, Cirocchi R. Laparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes. J Trauma Acute Care Surg 2020; 88:866-74. [PMID: 32195994 DOI: 10.1097/TA.0000000000002684] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adhesive small bowel obstruction (ASBO) is one of the most frequent causes of emergency hospital admissions and surgical treatment. Current surgical treatment of ASBO consists of open adhesiolysis. With laparoscopic procedures rising, the question arises if laparoscopy for ASBO is safe and results in better patient outcomes. Although adhesiolysis was among the first surgical procedures to be approached laparoscopically, uncertainty remains about its potential advantages over open surgery. Therefore, we performed a systematic review and meta-analysis on the benefits and harms of laparoscopic surgery for ASBO. METHODS A systematic literature review was conducted for articles published up to May 2019. Two reviewers screened all articles and did the quality assessment. Consecutively a meta-analysis was performed. To reduce selection bias, only matched studies were used in our primary analyses. All other studies were used in a sensitivity analyses. All the outcomes were measured within the 30th postoperative day. Core outcome parameters were postoperative mortality, iatrogenic bowel perforations, length of postoperative stay [days], severe postoperative complications, and early readmissions. Secondary outcomes were operative time [min], missed iatrogenic bowel perforations, time to flatus [days], and early unplanned reoperations. RESULTS In our meta-analysis, 14 studies (participants = 37.007) were included: 1 randomized controlled trial, 2 matched studies, and 11 unmatched studies. Results of our primary analyses show no significant differences in core outcome parameters (postoperative mortality, iatrogenic bowel perforations, length of postoperative stay, severe postoperative complications, early readmissions). In sensitivity analyses, laparoscopic surgery favored open adhesiolysis in postoperative mortality (relative risk [RR], 0.36; 95% CI, 0.29-0.45), length of postoperative hospital stay (mean difference [MD], -4.19; 95% CI, -4.43 to -3.95), operative time (MD, -18.19; 95% CI, -20.98 to -15.40), time to flatus (MD, -0.98; 95% CI, -1.28 to -0.68), severe postoperative complications (RR, 0.51; 95% CI, 0.46-0.56) and early unplanned reoperations (RR, 0.82; 95% CI, 0.70-0.96). CONCLUSION Results of this systematic review indicate that laparoscopic surgery for ASBO is safe and feasible. Laparoscopic surgery is not associated with better or worse postoperative outcomes compared with open adhesiolysis. Future research should focus on the correct selection of those patients who are suitable for laparoscopic approach and may benefit from this approach. LEVEL OF EVIDENCE Systematic Review/Meta-analysis, Level III.
Collapse
|
15
|
Detz DJ, Podrat JL, Muniz Castro JC, Lee YK, Zheng F, Purnell S, Pei KY. Small bowel obstruction. Curr Probl Surg 2020; 58:100893. [PMID: 34130796 DOI: 10.1016/j.cpsurg.2020.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Yoon K Lee
- Houston Methodist Hospital, Houston, Texas
| | - Feibi Zheng
- Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas
| | | | | |
Collapse
|
16
|
Farkas N, Wong J, Bethel J, Monib S, Frampton A, Thomson S. A systematic review of symptomatic small bowel lipomas of the jejunum and ileum. Ann Med Surg (Lond) 2020; 58:52-67. [PMID: 32953101 PMCID: PMC7486416 DOI: 10.1016/j.amsu.2020.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Small bowel lipomas are rarely encountered benign adipose growths found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. We aim to aid clinical decision-making and improve patient outcomes through this comprehensive review. Methodology The terms 'small bowel,' 'small intestine,' 'jejunum' and 'ileum' were combined with 'lipoma.' EMBASE, Medline and PubMed database searches were performed. All papers published in English from 01/01/2000-31/12/2019 were included. Simple statistical analysis (t-test, Anova) was performed. Results 142 papers yielded 147 cases (adults = 138, pediatric = 9). Male = 88, female = 59 (average age = 49.9 years). Presenting symptoms: abdominal pain = 68.7%; nausea/vomiting = 35.3%, hematochezia/GI bleeding = 33.3%; anaemia = 10.9%; abdominal distension = 12.2%; constipation = 8.9%; weight loss = 7.5%. Mean preceding symptom length = 58.1 days (symptoms >1 year excluded (n = 9)). Diagnostic imaging utilised: abdominal X-Ray = 33.3%; endoscopy = 46.3%; CT = 78.2%; ultrasound = 23.8%. 124/137 (90.5%) required definitive surgical management (laparotomy = 89, laparoscopcic = 35). 9 patients were successfully managed endoscopically. Lipoma location: ileum = 59.9%, jejunum = 32%, mesentery = 4.8%. Maximal recorded lipoma size ranged 1.2-22 cm.Mean maximum lipoma diameter and management strategy comparison: laparotomy 5.6 cm, laparoscopic = 4.4 cm, endoscopic = 3.7 cm, conservative = 4.5 cm. One-way Anova test, p value = 0.21. Average length of stay (LOS) was 7.4 days (range = 2-30). T-test p value = 0.13 when comparing management modalities and LOS. 4 complications, 0 mortality. Conclusions Important previously undocumented points are illustrated; a clearer symptom profile, diagnostic investigations utilised, size and site of lipomas, types and effectiveness of management modalities, associated morbidity and mortality. Open surgery remains the primary management. No statistically significant difference in LOS and lipoma size is demonstrated between management strategies. Endoscopic and laparoscopic techniques may reduce utilising invasive surgery in the future as skillset and availability improve.
Collapse
Affiliation(s)
- Nicholas Farkas
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
| | - Joshua Wong
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
| | - Jordan Bethel
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
| | - Sherif Monib
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
| | - Adam Frampton
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
| | - Simon Thomson
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
| |
Collapse
|
17
|
Abstract
Small bowel obstruction (SBO) accounts for 12-16% of emergency surgical admissions and 20% of emergency surgical procedures. Even with the advent of laparoscopic surgery, intra-abdominal adhesions remain a significant cause of SBO, accounting for 65% of cases. History and physical examination are essential to identify signs of bowel ischemia as this indicates a need for urgent surgical exploration. Another critical aspect of evaluation includes establishing the underlying cause for obstruction and distinguishing between adhesive and non-adhesive etiologies as adhesive SBO (ASBO) can be managed non-operatively in 70-90% of patients. A patient with a history of abdominopelvic surgery along with one or more cardinal features of obstruction should be suspected to have ASBO until proven otherwise. Triad of severe pain, pain out of proportion to the clinical findings, and presence of an abdominal scar suggest possible closed-loop obstruction. Computed tomography has higher sensitivity and specificity compared to plain films and is recommended by the Bologna guidelines. Correcting fluid and electrolyte imbalance is an initial crucial step to mitigate severe hypovolemia. Patients should proceed with surgery if symptoms of bowel compromise are present, or if symptoms do not resolve or have worsened. Surgery is indicated in patients with ischemia, strangulation, perforation, peritonitis, or failure of non-operative treatment. With advances in minimal access technology and increasing experience, laparoscopic adhesiolysis is recommended. Mechanical adhesion barriers are an effective measure to prevent adhesion formation.
Collapse
Affiliation(s)
- Jia Wei Valerie Tong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Pravin Lingam
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | | |
Collapse
|
18
|
Grasso S, Dilday J, Yoon B, Walker A, Ahnfeldt E. Status of Robotic-Assisted Surgery (RAS) in the Department of Defense (DoD). Mil Med 2019; 184:e412-e416. [PMID: 31216358 DOI: 10.1093/milmed/usz145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/15/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Since inception of robotic-assisted surgery (RAS) in 1999, there has been an exponential rise in RAS in both number and complexity of surgical cases performed. The majority of these cases are gynecologic surgery in nature, with only a quarter of them labeled as general surgery. The purpose of this study is to determine if RAS in the Department of Defense (DoD) mirrors these trends. METHODS A total of 6,204 RAS cases from across the DoD were reviewed between 01 January 2015 and 30 September 2017 from every Military Treatment Facility (MTF) that employs a robotic surgical device (various models of the da Vinci robotic surgical system by Intuitive Surgical). Specialty, number, and surgeon were recorded for each case. These end points were also examined for trends overtime and compared to similar civilian data. RESULTS The number of MTFs performing robotic surgery and the number of cases performed increased significantly. An average of 373 cases per quarter-year were performed in 2015, 647 in 2016, and 708 in 2017. The number of RAS cases increased by about 10% every quarter-year during this time period. RAS was most commonly performed by general surgery in 10 of the 14 MTFs examined. CONCLUSIONS MTFs implemented RAS much later than the civilian world. However, since its implementation, the frequency of RAS use has increased at a faster rate in the DoD than in the civilian world. Possible reasons for this are a younger pool of surgeons in the military and less demands on cost-effective productivity, allowing these younger surgeons to focus on emerging technology rather than maximizing surgical cost efficiency. General surgery constitutes the majority of RAS cases in the DoD. It is unclear why this difference from the civilian world exists.
Collapse
Affiliation(s)
- Samuel Grasso
- The Department of General Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Joshua Dilday
- The Department of General Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Brian Yoon
- The Department of General Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Avery Walker
- The Department of General Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Eric Ahnfeldt
- The Department of General Surgery, William Beaumont Army Medical Center, El Paso, TX
| |
Collapse
|
19
|
Shi WH, Chao HQ, Ye NY, Shi HJ. Ileus tube placement combined with laparoscopy in the treatment of refractory small bowel obstruction: Case series and literature review. Gastrointestinal Intervention 2019. [DOI: 10.18528/ijgii170020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Wei-Hai Shi
- Department of General Surgery, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| | - Hao-Qiang Chao
- Department of Radiology, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| | - Nian-Yuan Ye
- Department of General Surgery, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| | - Hong-Jian Shi
- Department of Radiology, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| |
Collapse
|
20
|
Quah GS, Eslick GD, Cox MR. Laparoscopic versus open surgery for adhesional small bowel obstruction: a systematic review and meta-analysis of case-control studies. Surg Endosc 2018; 33:3209-3217. [PMID: 30460502 DOI: 10.1007/s00464-018-6604-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Small bowel obstruction (SBO) due to adhesions is a common acute surgical presentation. Laparoscopic adhesiolysis is being performed more frequently. However, the clear benefits of laparoscopic adhesiolysis (LA) compared with traditional open adhesiolysis (OA) remain uncertain. The aim of this study was to compare the outcomes of LA versus OA for SBO due to adhesions. METHODS A systemic literature review was conducted using PRISMA guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Databases of all randomised controlled trials (RCT) and case-controlled studies (CCS) that compared LA with OA for SBO. Data were extracted using a standardised form and subsequently analysed. RESULTS There were no RCT. Data from 18 CCS on 38,927 patients (LA = 5,729 and OA = 33,389) were analysed. A meta-analysis showed that LA for SBO has decreased overall mortality (LA = 1.6% vs. OA = 4.9%, p < 0.001) and morbidity (LA = 11.2% vs. OA = 30.9%, p < 0.001). Similarly, the incidences of specific complications are significantly lower in the LA group. There are significantly lower reoperation rate (LA = 4.5% vs. OA = 6.5%, p = 0.017), shorter average operating time (LA = 89 min vs. OA = 104 min, p < 0.001) and a shorter length of stay (LOS) (LA = 6.7 days vs. OA = 11.6 days, p < 0.001) in the LA group. In the CCS, there is likely to be a selection bias favouring less complex adhesions in the LA group that may contribute to the better outcomes in this group. CONCLUSIONS Although there is a probable selection bias, these results suggest that LA for SBO in selected patients has a reduced mortality, morbidity, reoperation rate, average operating time and LOS compared with OA. LA should be considered in appropriately selected patients with acute SBO due to adhesions.
Collapse
Affiliation(s)
- Gaik S Quah
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | - Guy D Eslick
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | - Michael R Cox
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia. .,Discipline of Surgery, The University of Sydney Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
| |
Collapse
|
21
|
Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, Velmahos GC, Sartelli M, Fraga GP, Kelly MD, Moore FA, Peitzman AB, Leppaniemi A, Moore EE, Jeekel J, Kluger Y, Sugrue M, Balogh ZJ, Bendinelli C, Civil I, Coimbra R, De Moya M, Ferrada P, Inaba K, Ivatury R, Latifi R, Kashuk JL, Kirkpatrick AW, Maier R, Rizoli S, Sakakushev B, Scalea T, Søreide K, Weber D, Wani I, Abu-Zidan FM, De'Angelis N, Piscioneri F, Galante JM, Catena F, van Goor H. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2018; 13:24. [PMID: 29946347 PMCID: PMC6006983 DOI: 10.1186/s13017-018-0185-2] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023] Open
Abstract
Background Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
Collapse
Affiliation(s)
- Richard P G Ten Broek
- 1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,39Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Pepijn Krielen
- 1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Walter L Biffl
- 4Acute Care Surgery, The Queen's Medical Center, Honolulu, Hawaii USA
| | - Luca Ansaloni
- 3General Emergency and Trauma Surgery, Bufalini hospital, Cesena, Italy
| | - George C Velmahos
- 5Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | | | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM), Unicamp Campinas, São Paulo, Brazil
| | | | | | - Andrew B Peitzman
- 10Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ari Leppaniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | | | | | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | - Zsolt J Balogh
- 16Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | | | - Ian Civil
- 18Department of Vascular and Trauma Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Raul Coimbra
- 19Department of Surgery, UC San Diego Health System, San Diego, USA
| | - Mark De Moya
- Trauma, Acute Care Surgery Medical College of Wisconsin/Froedtert Trauma Center Milwaukee, Milwaukee, Wisconsin USA
| | - Paula Ferrada
- 21Virginia Commonwealth University, Richmond, VA USA
| | - Kenji Inaba
- 22Division of Trauma & Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA USA
| | - Rao Ivatury
- 21Virginia Commonwealth University, Richmond, VA USA
| | - Rifat Latifi
- 23Department of General Surgery, Westchester Medical Center, Westchester, NY USA
| | - Jeffry L Kashuk
- 24Department of General Surgery, Assuta Medical Centers, Tel Aviv, Israel
| | | | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Sandro Rizoli
- 27Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Boris Sakakushev
- 28Department of General Surgery, University of Medicine Plovdiv, Plovdiv, Bulgaria
| | - Thomas Scalea
- 29R Adams Crowley Shock Trauma Center, University of Maryland, Baltimore, USA
| | - Kjetil Søreide
- 30Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,31Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dieter Weber
- 32Department of General Surgery, Royal Perth Hospital, The University of Western Australia and The University of Newcastle, Perth, Australia
| | - Imtiaz Wani
- 33Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Fikri M Abu-Zidan
- 34Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Nicola De'Angelis
- 35Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France
| | | | - Joseph M Galante
- 37Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA
| | - Fausto Catena
- Emergency and Trauma Surgery, Parma Maggiore hospital, Parma, Italy
| | - Harry van Goor
- 1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
22
|
Hwabejire JO, Tran DD, Fullum TM. Non-operative management of adhesive small bowel obstruction: Should there be a time limit after which surgery is performed? Am J Surg 2018; 215:1068-1070. [DOI: 10.1016/j.amjsurg.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
23
|
Szeliga J, Jackowski M. Laparoscopy in small bowel obstruction - current status - review. Wideochir Inne Tech Maloinwazyjne 2017; 12:455-60. [PMID: 29362663 DOI: 10.5114/wiitm.2017.72330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Acute small bowel obstruction (SBO) is an urgent medical condition. Its diagnosis is based mainly on a clinical examination followed by confirmatory simple routine radiological examinations such as plain X-ray of the abdominal cavity or computed tomography (CT). However, a real surgical challenge is not a decision whether to perform a surgery, but a decision when and how to perform it. Aim To determine the place of laparoscopy in contemporary management of acute SBO based on the current literature. Material and methods A review of the literature based on the Medline database and including mainly the period of 2013–2017 was performed. Conclusions With regard to SBO, laparoscopy is a technique showing its advantages resulting from a minimally invasive approach. However, SBO is still a condition where the use of laparoscopy is limited mainly to selected cases such as SBO caused by single adhesions or foreign bodies. A basic limitation of using this technique is advanced and complicated SBO and lack of sufficient technical skills of the surgeon.
Collapse
|
24
|
Chiu AS, Jean RA, Davis KA, Pei KY. Impact of Race on the Surgical Management of Adhesive Small Bowel Obstruction. J Am Coll Surg 2017; 226:968-976.e1. [PMID: 29170020 DOI: 10.1016/j.jamcollsurg.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) represents roughly 15% of admissions by general surgeons. Management of SBO relies heavily on provider judgment, including decisions on how long to try nonsurgical management and whether to use a laparoscopic or open approach when surgery is needed. Given the subjective nature of these decisions, it is unknown if patient race influences management of SBO. STUDY DESIGN The National Surgical Quality Improvement Program was used to identify patients who underwent adhesiolysis or small bowel resection for adhesive SBO between 2010 and 2015 (n = 13,896). Adjusted logistic regression models incorporating patient comorbidity, American Society of Anesthesiologists (ASA) class, and emergency status were used to analyze odds of receiving surgery after 5 days from hospital admission (Eastern Association for the Surgery of Trauma guidelines) and of undergoing an open operation. RESULTS Patients who waited more than 5 days for a procedure had greater adjusted odds of postoperative complication (odds ratio [OR] 1.56 95% CI 1.37 to 1.79) compared with those waiting 5 days or less. Similarly, open procedures had higher odds of complication compared with laparoscopic (OR 2.31 95% CI 2.00 to 2.68). Regression analysis demonstrated that black patients were significantly more likely than white patients to wait more than 5 days for surgery (OR 1.31 95% CI [1.13-1.53]) and undergo open surgery (OR 1.56, 95% CI 1.36 to 1.79). There was no statistical difference for Hispanics patients waiting more than 5 days (OR 0.98, 95% CI 0.73 to 1.31) or receiving open surgery (OR 0.84, 95% CI 0.70 to 1.01) compared with white patients. CONCLUSIONS Clinical decisions regarding SBO management differ based on patient race. Future studies focusing on the surgical decision-making process and the influence of bias are needed.
Collapse
Affiliation(s)
| | - Raymond A Jean
- Department of Surgery, Yale School of Medicine, New Haven, CT; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kimberly A Davis
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, CT
| | - Kevin Y Pei
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, CT.
| |
Collapse
|
25
|
Yao S, Tanaka E, Matsui Y, Ikeda A, Murakami T, Okumoto T, Harada T. Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity score-matched analysis. Surg Endosc 2017; 31:5348-5355. [DOI: 10.1007/s00464-017-5615-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/16/2017] [Indexed: 12/22/2022]
|