Laparoscopic Management of Mechanical Small Bowel Obstruction: Are There Predictors of Success or Failure?

作者: M. Suter , P. Zermatten , N. Halkic , O. Martinet , V. Bettschart

DOI: 10.1007/S004640000104

关键词:

摘要: Background: Laparoscopy is used increasingly for the management of acute abdominal conditions. For many years, previous surgery and intestinal obstruction have been regarded as contraindications to laparoscopy because there an increased risk iatrogenic bowel perforation. The role in small remains unclear. Methods: Since 1995, data from patients undergoing laparoscopic entered prospectively into a database. Patients who underwent before 1995 were added retrospectively same charts all treated surgically mechanical reviewed. Univariate analysis was performed identify factors associated with success or failure, especially intraoperative complications, conversion, postoperative morbidity. Stepwise logistic regression assess independent variables. Results: This study included 83 (56 women 27 men) mean age 56 years (range, 17–91 years). Conversion necessary 36 cases (43%). alone successful 47 (57%). Intraoperative complications noted 16% 31% patients. Eight reoperations (9%) necessary. Mortality 2.4%. Duration (p < 0.001) diameter exceeding 4 cm (p= 0.02) predictors conversion. No factor complication identified. Accidental perforation 0.008) need conversion 0.009) only complications. Conclusions: Laparoscopic possible roughly 60% selected this approach. Morbidity lower, resumption normal diet faster, hospital stay shorter than requiring clear predictor failure identified, but must be avoided. If surgeon widely experienced advanced liberal policy, valuable alternative conventional obstruction.

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