Study examines challenges of laparoscopic adhesiolysis for bowel obstruction

A single-center retrospective study of 373 patients undergoing surgery for adhesive small bowel obstruction compared laparoscopic and open approaches, focusing on patients with prior abdominal surgery. Laparoscopy was associated with better postoperative outcomes in a propensity score–matched cohort, while dense adhesions and longer operations marked more challenging cases.

Matched analysis favored laparoscopy on short-term outcomes.
Dense adhesions caused most conversions to open surgery.
Higher BMI and prior malignancy surgery predicted dense adhesions.
Complication rates increased with longer laparoscopic operating times.

Researchers reviewed 373 consecutive patients who underwent surgery for adhesive small bowel obstruction at one center from 2009 to 2024. Among the 301 patients with prior abdominal surgery, the study compared postoperative outcomes after laparoscopic adhesiolysis (LA) and open adhesiolysis (OA), and assessed factors associated with dense adhesions and complications.

In a propensity score–matched cohort, LA was associated with faster bowel recovery, fewer complications, and shorter hospital stays than OA. Conversion to open surgery occurred in 15.8% of attempted laparoscopic cases; dense adhesions accounted for 68.4% of conversions. Complication rates after conversion were comparable to those after OA. Higher BMI and prior surgery for malignancy independently predicted dense adhesions. Each 15-minute increase in operative time was associated with higher odds of complications (OR 1.40, p<0.001); complication rates rose with longer LA operating times and approached those seen with OA.

The findings suggest potential short-term advantages of LA in selected patients, but also underscore the difficulty of predicting and managing complex adhesions. The retrospective, single-center design limits conclusions about comparative effectiveness, and the results support prudent case selection rather than a universal preference for either approach.

In practice

For patients undergoing surgery for adhesive small bowel obstruction, this single-center retrospective study found that laparoscopic adhesiolysis was associated with faster bowel recovery, fewer complications, and shorter hospitalization than open surgery in a propensity score–matched cohort. However, 15.8% of attempted laparoscopic procedures converted, usually because of dense adhesions, and complications increased with longer operating times. Higher BMI and prior malignancy surgery predicted dense adhesions. These findings may inform case selection, but do not establish that laparoscopy is preferable for every patient.

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Source

Surgical Endoscopy: Laparoscopic adhesiolysis for small bowel obstruction in patients with abdominal surgical history: what makes it technically challenging? ↗

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