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Laparoscopic Surgery For Small Bowel Obstruction Is Associated With A Higher Risk Of Bowel Injury: A Population-based Analysis Of 8,584 Consecutive Patients
Ramy Behman, Avery B Nathens, James Byrne, Stephanie Mason, Nicole Look Hong, Paul J Karanicolas
University of Toronto, Toronto, ON, Canada

Objective: Laparoscopic lysis of adhesions for small bowel obstruction (SBO) is becoming more common yet might increase the risk of bowel injury given the distended and/or potentially compromised small bowel. We set out to compare the incidence of bowel repair and/or resection in a large cohort of patients with adhesive SBO (aSBO) managed operatively.
Methods: We used administrative discharge data derived from a large geographic region, identifying patients who underwent surgery for their first episode of aSBO over 2005-14. Procedure codes were used to determine the exposure: either an open approach or a laparoscopic approach (including procedures converted to open). The primary outcome was incidence of bowel intervention, defined as intraoperative enterotomy, suture repair of intestine, or bowel resection. We estimated the odds of bowel intervention after adjusting for patient and clinical factors, including time-to-operation.
Results: 8,584 patients underwent operation for aSBO. Patients undergoing laparoscopic procedures were younger with fewer comorbid conditions. Laparoscopic approaches increased more than 3-fold over the study period (4.3% to 14.3%, p<0.0001). The incidence of bowel intervention was 53.5% vs 43.4% in laparoscopic vs open procedures (p<0.0001). After adjustment for potential confounders, the odds of bowel intervention among patients treated laparoscopically versus open was 1.6 (95%CI: 1.4-1.9).
Conclusions: Laparoscopic procedures for aSBO are associated with a greater likelihood of need for intervention for bowel injury and/or repair. This increase might be due to challenges inherent with laparoscopic approaches in patients with distended small bowel. Laparoscopic approaches in this patient population should be accompanied by considerable caution.

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