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Journal of Minimally Invasive Surgery 2020; 23(2): 65-66
Published online June 15, 2020
https://doi.org/10.7602/jmis.2020.23.2.65
© The Korean Society of Endo-Laparoscopic & Robotic Surgery
Laparoscopic Adhesiolysis for Small Bowel Obstruction: Effective Alternatives or Immoderate Challenge?
Byung Mo Kang 
, M.D., Ph.D.
Correspondence to : Byung Mo Kang Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Korea Tel: +82-33-240-5787 Fax: +82-33-240-5879 E-mail: kbm0728@yahoo.co.kr ORCID: https://orcid.org/0000-0003-0900-094X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Laparoscopic lysis for intraperitoneal adhesion should be performed only in selective patients with small bowel obstruction by experienced surgeons. Current evidence is insufficient to postulate that laparoscopic surgery is safe and effective alternative treatment option for small bowel obstruction.
Keywords Laparoscopy, Small intestine, Intestinal obstruction, Tissue adhesions
In the early days of laparoscopic surgery, previous history of abdominal surgery had been considered to be one of absolute contraindications for laparoscopic surgery.1 With increasing the experiences of laparoscopic surgery, it’s indication has been gradually expanded. Several authors reported safety and feasibility of laparoscopic surgery in the presence of intraperitoneal adhesion caused by previous abdominal surgery.2,3 Furthermore, even the dissection of intraperitoneal adhesion has been performed with laparoscopic techniques.4,5
However, laparoscopic procedure has inherently potential risks of organ injury due to limited tectile sensation/feedback and confusing spatial orientation. Therefore, laparoscopic adhesiolysis should be performed in highly selective cases by experienced surgeons. According to the location and degree of intraperitoneal adhesion, proper laparoscopic instruments should be chosen and sufficient traction and operative field should be secured. Even if laparoscopic approach is initially attempted, the surgeon should be able to determine conversion to open surgery when surgical safety is not guaranteed. In order to enhance the ability of each surgeons, systemic and effective education curriculum for minimally invasive surgery is needed.
The authors tried to compare short-term clinical outcomes between laparoscopic and open adhesiolysis in the patients with small bowel obstruction. In this study, laparoscopic adhesiolysis had less blood loss and earlier functional recovery, as consistent with general benefits of laparoscopic surgery. Additionally, this study showed that laparoscopic adhesiolysis had lower rates of readmission and reoperation. However, this results was not enough to confirmatively determine the superiority of laparoscopic procedures for intraperitoneal adhesion. As the authors mentioned in the limitation of this study, there might be selection bias that the degree of intraoperative adhesion was less severe in the laparoscopic surgery group, compared with the open surgery group. Therefore, well-designed, prospective study should be conduct to verify and confirm this finding in the near future.
CONFLICT OF INTEREST
None.
None.
- Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000;80:1093-1110.
- Arteaga González I, Martín Malagón A, López-Tomassetti Fernández EM, Arranz Durán J, Díaz Luis H, Carrillo Pallares A. Impact of previous abdominal surgery on colorectal laparoscopy results: a comparative clinical study. Surg Laparosc Endosc Percutan Tech 2006;16:8-11.
- Vignali A, Di Palo S, De Nardi P, Radaelli G, Orsenigo E, Staudacher C. Impact of previous abdominal surgery on the outcome of laparoscopic colectomy: a case-matched control study. Tech Coloproctol 2007;11:241-246.
- Kim SM, Park JH, Kim BC, Kang BM, Kim JW, Kim JY. Safety and Feasibility of Laparoscopic Surgery for Small Bowel Obstruction. J Minim Invasive Surg 2018;21:75-81.
- Mancini GJ, Petroski GF, Lin WC, Sporn E, Miedema BW, Thaler K. Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg 2008;207:520-526.
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Editorial
Journal of Minimally Invasive Surgery 2020; 23(2): 65-66
Published online June 15, 2020 https://doi.org/10.7602/jmis.2020.23.2.65
Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.
Laparoscopic Adhesiolysis for Small Bowel Obstruction: Effective Alternatives or Immoderate Challenge?
Byung Mo Kang , M.D., Ph.D.
Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
Correspondence to:Byung Mo Kang Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Korea Tel: +82-33-240-5787 Fax: +82-33-240-5879 E-mail: kbm0728@yahoo.co.kr ORCID: https://orcid.org/0000-0003-0900-094X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Laparoscopic lysis for intraperitoneal adhesion should be performed only in selective patients with small bowel obstruction by experienced surgeons. Current evidence is insufficient to postulate that laparoscopic surgery is safe and effective alternative treatment option for small bowel obstruction.
Keywords: Laparoscopy, Small intestine, Intestinal obstruction, Tissue adhesions
Body
In the early days of laparoscopic surgery, previous history of abdominal surgery had been considered to be one of absolute contraindications for laparoscopic surgery.1 With increasing the experiences of laparoscopic surgery, it’s indication has been gradually expanded. Several authors reported safety and feasibility of laparoscopic surgery in the presence of intraperitoneal adhesion caused by previous abdominal surgery.2,3 Furthermore, even the dissection of intraperitoneal adhesion has been performed with laparoscopic techniques.4,5
However, laparoscopic procedure has inherently potential risks of organ injury due to limited tectile sensation/feedback and confusing spatial orientation. Therefore, laparoscopic adhesiolysis should be performed in highly selective cases by experienced surgeons. According to the location and degree of intraperitoneal adhesion, proper laparoscopic instruments should be chosen and sufficient traction and operative field should be secured. Even if laparoscopic approach is initially attempted, the surgeon should be able to determine conversion to open surgery when surgical safety is not guaranteed. In order to enhance the ability of each surgeons, systemic and effective education curriculum for minimally invasive surgery is needed.
The authors tried to compare short-term clinical outcomes between laparoscopic and open adhesiolysis in the patients with small bowel obstruction. In this study, laparoscopic adhesiolysis had less blood loss and earlier functional recovery, as consistent with general benefits of laparoscopic surgery. Additionally, this study showed that laparoscopic adhesiolysis had lower rates of readmission and reoperation. However, this results was not enough to confirmatively determine the superiority of laparoscopic procedures for intraperitoneal adhesion. As the authors mentioned in the limitation of this study, there might be selection bias that the degree of intraoperative adhesion was less severe in the laparoscopic surgery group, compared with the open surgery group. Therefore, well-designed, prospective study should be conduct to verify and confirm this finding in the near future.
CONFLICT OF INTEREST
None.
FUNDING
None.
ACKNOWLEDGMENTS
None.
References
- Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000;80:1093-1110.
- Arteaga González I, Martín Malagón A, López-Tomassetti Fernández EM, Arranz Durán J, Díaz Luis H, Carrillo Pallares A. Impact of previous abdominal surgery on colorectal laparoscopy results: a comparative clinical study. Surg Laparosc Endosc Percutan Tech 2006;16:8-11.
- Vignali A, Di Palo S, De Nardi P, Radaelli G, Orsenigo E, Staudacher C. Impact of previous abdominal surgery on the outcome of laparoscopic colectomy: a case-matched control study. Tech Coloproctol 2007;11:241-246.
- Kim SM, Park JH, Kim BC, Kang BM, Kim JW, Kim JY. Safety and Feasibility of Laparoscopic Surgery for Small Bowel Obstruction. J Minim Invasive Surg 2018;21:75-81.
- Mancini GJ, Petroski GF, Lin WC, Sporn E, Miedema BW, Thaler K. Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg 2008;207:520-526.
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