Introduction
Major abdominal operations result in severe unpredictable scar tissue formation that may contribute to adhesions and then recurrent attacks of acute bowel obstruction, chronic abdominal pain, or both problems. Laparoscopic adhesiolysis provides good relief of symptoms in patients with chronic abdominal pain and/or acute bowel obstruction but without major previous abdominal surgery or severe peritonitis (necrosis or perforation). Early laparoscopic intervention for acute or chronic bowel obstruction has been tried many times worldwide but without complete data about the safety and outcome for both conditions.
Patients and methods
Between February 2017 and January 2019, a prospective randomized controlled study was done on 32 patients admitted for small bowel obstruction (14 patients with acute bowel obstruction and 18 patients with chronic small bowel obstruction). Patients selected for early laparoscopic adhesiolysis were those who had no preoperative finding of perforation, torsion, strangulation, or any clinical signs or radiological evidences of peritonitis. The outcome of the study was evaluated depending on length of postoperative hospital stay, enteral nutrition, 30-day mortality, positive bowel movement and stool passage, the length of sick leave (return to work), and recurrence of bowel obstruction during the 2-year follow-up.
Results
A total of 32 patients with a diagnosis of small bowel obstruction were identified and divided into two groups. Group A included 18 patients with chronic bowel obstruction who were treated with laparoscopic adhesiolysis, and group B included 14 patients having acute intestinal obstruction who were treated with laparoscopic adhesiolysis. The follow-up period was ∼24 months.
Conclusion
Laparoscopic adhesiolysis is a safe and effective management option for patients with prior abdominal surgery with acute or chronic abdominal pain or recurrent bowel obstruction.