Laparoscopy seems to have an advantage above laparotomy in terms

Laparoscopy seems to have an advantage above laparotomy in terms of adhesion formation to the abdominal wall and to the operative site [98, 99]. Laparoscopic adhesiolysis for small bowel obstruction has a number of potential advantages: (1) less postoperative pain, (2) quicker

return of intestinal function, (3) shorter hospital stay, (4) reduced recovery time, allowing an earlier return to full activity, (5) fewer wound complications, and (6) decreased postoperative adhesion formation [100]. However No randomized controlled trial comparing open to laparoscopic adhesiolysis exists up to date, and both the precise indications and specific outcomes of laparoscopic adhesiolysis for adhesive SBO remain poorly understood. The only RCT on laparoscopic adhesiolysis assessed the incidence of chronic abdominal pain after selleck randomization to laparoscopic adhesiolysis or no treatment during diagnostic laparoscopy and it failed to demonstrate any significant differences in terms of pain or discomfort [101]. Although data from retrospective

clinical controlled trials suggest that laparoscopy seems feasible and better in terms of hospital stay and mortality reduction, high quality randomised controlled trials RepSox purchase assessing all clinically relevant outcomes including overall mortality, morbidity, hospital stay and conversion DNA-PK inhibitor are lacking [102]. Although the adhesiolysis hospitalization rate has remained constant in USA since 1988, inpatient expenditures have decreased by nearly 10% because of a 15% decrease in the average length of stay (from 11.2 days in 1988 to 9.7 days in 1994) [103]. From this large population Hospital Discharge reports Survey, is derived that laparoscopic less invasive surgical techniques for adhesiolysis, increased over the last years, have contributed to the decreased time required in the hospital for both the surgical procedure itself and the recovery time. However the increased use of laparoscopy during this study period Gemcitabine cell line did not appear to be associated with a concomitant reduction in the adhesiolysis hospitalization rate therefore a common denominator may exist

between surgical trauma and immune response to foreign bodies. When deciding between an open or laparoscopic approach, the first consideration is that the surgeon be trained and capable of performing advanced laparoscopy. With regards to patient selection, patients with an acute small bowel obstruction and peritonitis or free air requiring an emergent operation are best managed with a laparotomy. Patients without peritonitis who do not resolve with nonoperative management should be considered for laparoscopic adhesiolysis. In these cases, it is important to consider the bowel diameter, degree of abdominal distention, and location of the obstruction (ie, proximal or distal). Suter et al [104] found that a bowel diameter exceeding 4 cm was associated with an increased rate of conversion: 55% versus 32% (p = 0.02).

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